Seeking Therapyby Meneika Chandler, LPC on 03/12/21
**WARNING! This is a long post! Apologies in advance, but
I hope that you find it helpful. Grab a snack and get comfy.
If you take anything from this Blog I want it to be this:
Invest in you!**
I hope that you find it helpful. Grab a snack and get comfy.
If you take anything from this Blog I want it to be this:
Invest in you!**
In the midst of Pandemic 2020/2021, mental health support has become a key topic of interest. It has had a lasting impact on us as a society and as individuals. If you are reading this, you have been affected.
Social distancing has kept us inside and separated.
People have lost loved ones due to the coronavirus.
Medical professionals have had to minister to staggering numbers of sick and dying.
Vacation plans have changed to quarantines and lock-downs.
Students have had to fluctuate between home instruction and distanced in-person classrooms while missing school and sporting events, even graduation ceremonies.
Expectant mothers have had to plan for isolated births and fewer options.
Business owners have had to change how they operate and some have closed their doors. Families have had to forego gathering.
Visiting hours have been reduced to waving through windows.
Technology has elevated from luxury to necessity.
Employees have had to adjust to altered work expectations.
Communities have had to struggle through limited access to supplies and goods.
Stress is high and we are stressed to our breaking point.
In a preliminary study of the impact of COVID-19 on mental health in the US, significant increases in symptoms of anxiety, depression, trauma/stress, substance use, and suicidal thoughts were reported. Higher rates of symptoms were reported among specific subgroups, including young people ages 18 to 24, those in the Hispanic and black communities, those with previously diagnosed mental health disorders, essential workers, and those who are unpaid caregivers to adults. (Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1)
The need for access to therapists is greater than ever. The question then becomes, how can people connect to a therapist? This is what I hope to answer with this post.
ACCESS TO THERAPY DURING THE PANDEMIC
Since the declaration of a health emergency, federal and state health departments as well as insurers have extended waivers for sanctions and restrictions in an effort to increase mental and behavioral health resources to the community. These waivers have allowed providers to provide services in ways they were not able to do prior to the pandemic.
- Telehealth options have been permitted by most states and approved for coverage by most insurances, enabling therapists to be more accessible to those in need.
- Many states have adopted temporary provisions allowing licensed mental health providers to practice across state lines. This has allowed therapists to be able to reach people in areas with limited numbers of therapists available.
- HIPAA (Health Insurance Portability and Accountability Act) restrictions have been waived which limited the ways that therapy could be conducted. This has enabled people in rural areas with limited internet or those with limited technology or technological savvy to access their therapists through a simple phone call in the comfort of their won home.
THOUGHTS ABOUT SEEKING A THERAPIST
With systems in place to make therapy available during this trying time, the next step is encouraging people to access therapy.
Often people think about reaching out to a therapist long before they do. They hesitate to reach out for therapy, often dealing with their struggles alone. There may be many reasons for this. I am going to address some common ones that people have shared with me about delaying therapy.
I n t e r n a l W o r r i e s
Many people have shared that they delayed seeking help because of their internal fears or worries.
Maybe they have this inner voice that says, “I don’t want to bother anyone.” I hear that a lot.
Maybe that voice says, “I should be able to handle my problems on my own.” I hear that a lot as well. (That voice is sometimes NOT the voice of the person but of a critical-someone-else from long ago.)
Or maybe it says, “My problems aren’t bad enough to see a therapist.”
Or, “My problems are too bad and a therapist will think I’m crazy.”
Or, “Maybe I am crazy and going to a therapist will prove it.”
If any of these voices sound familiar, I have something very important to write to you…YOU ARE NOT A BURDEN! What you feel and think and experience is important and we therapists are not at all bothered by it.
…Also, YOU ARE NOT WEAK FOR COMING TO TALK TO A THERAPIST!! On the contrary, it takes an inner strength to open up to a person you do not yet know and tell them your intimate thoughts and experiences. We appreciate that strength in you and we recognize that it is that strength that brings the healing.
…Also THERE IS NOT A MEASUREMENT FOR STRUGGLE! A struggle is a big enough struggle to bring to therapy when it is causing you pain or anxiety or fear or sadness. It doesn’t have to grow. And you don’t have to keep it inside until it does.
…Also, NO, YOU ARE NOT CRAZY!!!
…Also, LANGUAGE MATTERS. The word “Crazy” is an old slang term that is loosely defined as everything from “mentally deranged” to “extremely enthusiastic” (Google Dictionary). It is indefinable, unmeasurable, misleading, and inaccurate. It is a word that is used to abuse and demean ourselves or others. If we are going to practice “dignity” (see my blog titled “It Begins with Dignity”), we are going to find that there will be times when we need to change the language that we use, with others and with ourselves.
I n t i m i d a t i n g P r o c e s s
Finding a therapist can be very intimidating. People who live in big metropolitan areas where there are many therapists who may specialize in specific treatment methods, treat specific conditions, and work with certain populations may feel overwhelmed by the options. In more rural areas, it may be difficult to find a therapist with openings or with specializations or who take a certain clientele or insurances. The influx of online for therapists has introduced additional options.
How can a person know where to start?
And how can a person know which therapist is a good fit?
Starting the search for a therapist is much like looking for anyone to do any kind of service, like a good doctor, a good mechanic, a good contractor, and so forth.
- Ask a friend – Word-of-mouth can be a great way to find out about local therapists. Asking friends who are comfortable with sharing their therapy experience for recommendations will usually provide a pretty good starting point. They can give insight to their perspective of a therapist’s personality, methods, and overall things to expect.
- Ask a Professional – Asking another professional how to find a therapist is another great way to find a therapist. Your primary care doctor will most definitely have a list of therapists in your area! This is part of your doctor’s overall wellness resource package! Give them a call and ask!
Also, your school counselor can help you start your search! Whether you are in elementary school, middle school, high school, public school, private school, college, grad school, technology school, trade school…there are counselors and advisers who can connect you with names of therapists! Reach out! Let them know you are looking for a therapist!
- Check the Insurance Directory of Network Providers – Some health insurance companies have a directory of providers that are in-network with their insurance. This is true of therapists. Starting with the provider directory will not only give a list of mental health providers but will also assure that the therapist you choose can take your insurance.
- Check the Licensing Website – Every state will have a licensing board or two for therapists. Typically therapists will be one of two educational backgrounds: social work or professional counseling, although they may have a different title. Both have to be licensed by their respective licensing boards in order to practice.
A search for “board of social work” or “board of professional counseling” in each state should offer a link to the licensing board. And each web page for the licensing board should have a link for “license search” or “counselor search” and a way to search the therapists that have an active license with that state. A general search for a city can yield a list of ALL licensed therapists in that city who are licensed through that board.
- “Google It” – Though this has become a lighthearted representation of our technology-full lives, searching for a therapist in your area is another way to get a list of therapists, though it may be tiring and it may require a good deal of time browsing. Likely, the first several recommendations may be from www.psychologytoday.com, or www.goodtherapy.org, or other such professional listing sites. This is an association and the therapists on this site have paid membership or advertising fees to be listed there with their bios and pictures. These therapists are some of your choices, but are not all of the licensed therapists in your area. Keep scrolling and you will find other recommendation compilations as well, such as www.healthgrades.com, which will list therapists who have registered for credentialing, meaning they have signed up to be reviewed and considered by insurances companies. Again, this is some but not all of the licensed therapists in an area. But it is a start.
Googling a therapist you are given as a recommendation by some of the other methods can give you more insight about that therapist. Many therapy practices and individual therapists have websites with pictures and bios and a list of things that they generally treat that you can read and review. You can tell a lot by their websites, such as what their philosophy is about mental wellness or what kind of language they use to talk about their work.
- Cold Calling – Calling a therapist’s office and asking questions is a great way to directly find out about that therapist and practice. If there is a receptionist answering the phone, they can usually give you a pretty good overview of the therapist and their work. And if there is not, we therapists are usually happy to answer questions you might have about us and about therapy in general.
It can be anxiety provoking to call people directly and ask questions. Sometimes it helps to write your questions down so they are ready when you call. They might look something like this:
- Do you have openings?
- Do you work with adults/children/seniors?
- Do you take this insurance?
- Do you work with people who have _____ (anxiety, depression, stress, developmental struggles, relationship issues, and so forth)?
Often, people will call my office and will just explain what is going on in their world and we will work through their questions from there. For example, they may call and say, “I think my child may need to see someone. They have been really struggling with the COVID changes and are having a hard time in school. They don’t get to see their friends and they are staying to themselves a lot.” I will pick up right from there and we will talk about everything they need to know to make a decision about therapy.
The cost of therapy is a big consideration for people, and sometimes a barrier. The cost of counseling sessions vary by areas within a state, typically more expensive in areas with higher cost of living and less expensive in areas with lower cost of living.
The very first appointment is usually an intake appointment. This appointment is longer than a regular appointment and usually includes a lot of background gathering so that the therapist can learn about the client’s history and experiences. These are more expensive than a regular appointment. Typical cost out of pocket for a regular appointment can be anywhere from $80 to $160 or more per session, depending on the area. Intakes may range from $125 to $300. These are just ball park estimations.
This is a lot, I know.
Why is therapy so expensive?
Let’s look for a minute at what goes into rate setting.
The reason for the high cost of the session is related to the level of responsibility and liability that the therapist accepts when they agree to see a person for counseling. A therapist must be able to identify areas of need, develop a collaborative treatment plan, and administer the interventions required to meet the needs of that client. This includes proper diagnosing, understanding of tools and methodology to treat the identified conditions, and ongoing research, resources, and recommendations to help that client reach their goals. It is an incredible responsibility. And it requires an unbelievable amount of time both in the session hour and outside of that hour.
An intake for services takes over an hour and it requires preparation time before the intake as well as follow up work afterward. A 1 ½ hour intake will generally translate to 7 hours of work. So if I charge $100, for example, for the intake, it comes to $14.29 per hour.
What is involved with an intake?
Lets talk about what you can expect in a therapy intake with an example of someone who comes to see me with anxiety-related experiences. I start preparing to see this client before the appointment. I look over their registration paperwork, which consists of questions related to their area of concern, family history, and questions related to wellness, like “how would you describe your sleep” and “describe your substance use.” These questions are important for me to be able to have a more complete picture of the needs and struggles this client may be facing.
My first visit with this client is for an hour and a half. Sometimes we may go through it faster, if, for example, I am working with a child or an adult who is overwhelmed by the process and needs to have a shorter time. In these cases, I may need several sessions to do an intake, but the other sessions would be at the regular rate. In the intake, we meet each other, we talk about therapy and I answer any questions they may have about therapy or about me. And we start to uncover their concerns. Here we also talk about how we will start our work together.
After the intake, I have a lot of work to do for this client. I have to take all of the information I have gathered from their registration packet and from our intake and I have to do all of the necessary referencing, researching, and exploring that is required to make at least a preliminary diagnosis and develop the sketch of a treatment plan that we can go over together. This is important and I have to be very conscientious about the research I do. Sometimes I need more information, such as if the person has been to other therapists or psychiatrists or has been in treatment. I may need to request paperwork from those providers, with the person’s consent. I may need to collaborate with another treating psychiatrist or physicians with that person’s consent. I may need to collaborate with behavior therapists or school officials or courts with that person’s consent.
All of this additional work is non-billable time. Not able to be billed to insurances or to the client. It is considered part of the session fee. The fee I charged for the intake is intended to cover all of the non-billable case coordination, planning, and collaborating.
This is just example and an overview, but it is really pretty typical of the experience I have as a practitioner.
How can I afford therapy?
Fortunately, there are some ways to make therapy attainable to everyone, even if you have limited income.
- Insurance – Most insurance companies, especially since the Affordable Care Act, have included mental health services under their covered services. You can call your insurance company and ask if it covers therapy and if there is a limit to how many visits you can make on the plan. Many times, you and your therapist can negotiate for additional visits based on your need.
Some insurances say they cover therapy visits, but may apply those visits to your deductible. (Insert angry-faced-emoji here!) Personally, I think this is ridiculous and therapy should be treated as “primary care” which is generally covered and apart from deductible. This is definitely a question to ask your insurance! If this is the case, your insurance would be billed but whatever they apply to the deductible would be charged to you out of pocket.
- Income Based Options – There are therapy practices, usually non-profits, who offer income based rates, also referred to as “sliding scale.” These practices, and the therapists who work with them, usually get grants or other funding to offset the cost of the services. You would have to apply to be considered which would include providing your financial information such as pay stubs and tax information. This is used to calculate the rate you are charged.
Don’t think that because the therapist is working for a non-profit or a community health facility that they are not as qualified or concerned about you! They have the same requirements for licensure and continued training as all other therapists. If you really struggle to make a living and would like to seek therapy, these programs are available!
- Shorter Session Times at Reduced Cost – Sometimes therapists will offer shorter session times to be able to fit your out of pocket budget. This is something we do at my practice. We offer 30 minute, 45 minute, and 60 minute session with pricing for each when a person either does not have insurance to cover the cost or their insurance is applying their visits to their deductible. We will maximize that reduced time! You may have homework! It will take us working as a team! But we would rather someone have access to therapy, even for less time, than to not reach out and to struggle without it.
- Pro-Bono Work – Pro-Bono means “work undertaken without charge” (Google dictionary). Free services. Did you know, in most states, therapists are required to provide some pro-bono work as part of licensure? Yep! There is usually not a time requirement, like a certain number of hours of pro-bono work per year, but they are required to offer some! They may do this in a variety of ways, of course. In our area, many providers collaborate with outreaches, such as youth outreaches, shelters, detention facilities, and so forth, to give their time and expertise to the community. Reach out to some of the organizations and see what might be available and if you qualify.
A H i s t o r y
I know this has been a lot of information, but hang in there, we are almost done! I need to address one more very important hurdle that some people have related to seeking therapy and that is A HISTORY.
Sometime people’s experience with therapy has not been good. They may have been forced to go to therapy as kids. Maybe they were subject to aversive therapy interventions, such as some behavior therapies or therapies that have been banned like conversion therapies. Maybe they have been to non-licensed practitioners who did not really know what they were doing. Maybe they had a therapist who was unethical and broke trust with them. Maybe they didn’t connect with their therapist because of personality differences or cultural differences or religious biases or gender biases that felt like barriers that could not be overcome.
There can be any number of reasons that a person may have had an unpleasant therapy experience and have since stayed away.
If this is the case for you, I encourage you to reach out, continue looking, stay open to the possibility of a connection with another therapist. DON’T GIVE UP ON YOU!!
Feel empowered to seek a therapist who will listen and will commit.
Overcoming a negative experience in a professional setting can be tough, but it is possible. Some personal disclosure, I have had to work through some really tough experiences with professionals. Dentists. Its true. I have had trauma triggers during dental appointments that have been temporarily crippling. A natural response during this kind of situation is to avoid it. Leave. Don’t go back. I have done all of these. BUT…I need a dentist! And to be fair, the dentists often had no idea that I was triggered or that I might be triggered. So I have to do a couple of things to advocate and to prepare for myself. First, I need to find a dentist I feel comfortable talking to about my triggers and asking to partner with me to have a plan if triggering occurs. Second, I need to communicate any discomfort so they can make adjustments.
Some things that you might consider as you open up to the possibility of seeking therapy again:
- Therapists are as different as people are different. Watch for times when you might assume what they are like before investigating.
- Talk to them, let them know your concerns about past history. See how they respond. If you feel that you can trust them and they are considerate of you as an individual, try a few sessions.
- Therapists do sometimes piss you off. They may challenge you and confront you. They may not tell you what you want to hear. They may not do the therapeutic intervention the way you want them to. The therapist may have to do things, such as make reports, when there is a danger of harm or exploitation. This may happen. But all of this should with full disclosure and with a spirit of compassion, empathy, non-bias, and full commitment to your wellness and healing. Even though these things may be hard to walk through, they can be just what is needed to bring trust and healing during very difficult times.
Though I openly encourage people to seek therapy whenever they feel they need it, even if there is not a current crisis, I strongly urge people to seek therapy when there is one. I’d like to close this blog with information about how to identify a mental health emergency.
- Unusual and uncharacteristic behavior for the person, such as not speaking or rapid speech, refusing to eat, not caring for themselves, paranoia, not sleeping for days at a time, engaging in risky behavior such as excessive substance use, reckless driving, aggression. These can indicate a mental health situation and at the very least the person should see their medical professional.
- Threatening to harm themselves or others is a mental health emergency that should not be ignored. If it is safe, this person can be taken for evaluation at their doctor’s office, a nearby hospital, a or community mental health facility. If they are not safe to transport, it may be necessary to call 911.
**Here I want to say that many states and localities have CIT (Crisis Intervention Team) programs in which officers are trained to respond to a mental health emergency in a non-lethal manner. This is a program that is collaborated through NAMI (National Alliance on Mental Illness) and you can find more information on this here https://www.nami.org/Advocacy/Crisis-Intervention/Crisis-Intervention-Team-(CIT)-Programs. If you suspect that the person is having a mental health emergency and the level of danger is high to warrant a 911 call, please indicate it as a Mental Health Emergency and request CIT trained officers. If safe, stay with the person or nearby to facilitate their safety.
- Suicidal thoughts or comments are a mental health emergency and the first step is this: BELIEVE THEM!
It is better to be responsive to suicidal thoughts and comments and find out that it really was not an emergency than to not be responsive and learn that it really was.
Reach out to a doctor, a teacher, a therapist, a trusted adult who can connect them with help.
Call the National Suicide Prevention Hotline at 1-800-273-8255 or https://suicidepreventionlifeline.org/.
Maybe the person has not said that they are suicidal.
Maybe they have just withdrawn, are not engaging in activities that they used to.
Maybe they comment that things would be better if they were not here.
Maybe it is you.
Maybe you feel this way.
YOU ARE IMPORTANT!