Finding The Right Therapist – Key 4: Cost and time matter!
Here comes reality. . . just because we define what we want AND it fits our needs does not mean we can automatically have it. We must have the resources to get it. This is where I get practical. Psychotherapy is a service. It costs money. And time. Though many people who choose psychotherapy as a profession are altruistic and genuinely want to help people, they also need to make money to live (and pay off all those student loans from graduate school!) and they have schedules to keep just like you. So, we must take that list of potential providers that meet professional qualifications, treat your issue, and meet your preferences and ask them, “what will this cost and can we schedule a regular time to meet?”
How much time and money?
Psychotherapy can range anywhere from $65 - $300 per session (which is about 45 - 55 minutes long) in most areas of the United States. The service price will typically correlate with the cost of living in your geographical area. Professionals charge what their market can afford. Most therapists see people weekly or biweekly to start and gain momentum, and then frequency tapers off as symptoms become relieved and changes are solidified. The average number of sessions for most treatments is 10 - 12. Some people find relief in 8 sessions and others stick around for years because of their need for ongoing maintenance or the valuable benefits therapy adds to their everyday lives. But you get it, therapy is an investment of time and money.
Can I use insurance?
Thanks to lawmakers, most insurance carriers now provide coverage for mental health issues. Review your benefits and talk to your insurance provider to determine what and who they are willing to pay on your behalf. The provider you choose must be in network to get the maximum coverage. Further, expect that you will have some copay to contribute. And if you are on a high deductible plan, you may need to upfront a lot of the cost. If you want to stick to the list or preferred providers you created, you may need to use out of network benefits. That said, insurance isn’t always your best choice.
Here’s the catch with using your insurance for psychotherapy services. By all means, insurance is helpful and if you need it financially, you should use it! But insurance can limit who you can see, the type of treatment you receive, how many sessions you have, how frequently those sessions are, what the goals of therapy are, and what qualifies as successful treatment. . . without even knowing your actual problem, circumstances, context, and preferences. So, rather than letting you and the therapist make the best choices for your needs and situation, your insurance company retains a heavy hand in influencing those decisions.
Additionally, using insurance means giving up some of your privacy. In order to use your benefits, the psychotherapist will have to provide the insurance company with a diagnosis, and often some sort of treatment plan. That diagnosis will be on your record and can follow you. It can potentially be seen by your insurance agent, the staff at your third party biller, your HR representative at work, other physicians on your care team and their office staff, and even law enforcement in an emergency. I remember one time distinctly when I went for an eye exam and the technologist fitting me for glasses reviewed my chart and asked me about a gynecological issue I had in the past. Taken aback, I asked how he knew that and he told me it was listed on my profile in the health network! Before you freak out, let me remind you that in many cases, like an emergency, it is good for healthcare providers to have a whole picture of your health needs. AND, let me stand up against the stigma of mental health and say that getting a diagnosis should not be the reason you refrain from getting treatment; you have no reason to be ashamed of it. Diagnoses are useful for understanding symptoms, coordinating care, providing treatment, accessing your insurance benefits, and promoting funding for mental health research. A diagnosis does not define you! Unfortunately, society has not caught up with that idea yet and people can still make inaccurate judgments. In the end, you need to be the one to make the decision about your privacy and what you allow others to know about your mental health.
One more thing about insurance and diagnoses. . . the majority of plans do not cover marital therapy or family therapy. I know-- super frustrating! If only insurance companies would realize that healthy couples and healthy families nurture healthy individuals, which essentially lowers the need for mental health care (and associated costs) instead of increasing it! But, alas, they are not fully enlightened yet so we have to work within the system. What that means is that one person in the couple or family must get a diagnosis in order for insurance to cover services. And, the treatment plan and sessions must be focused on that person’s symptoms and needs. The reality is that many really good and ethical therapists find a way to make that work and ultimately help the couple and family. However, it still boils down to identifying one person in the couple or the family as the “patient” (which others often assume means “cause of the problem”) and that carries weight for the person, their partner, their relationships, and other family members. It also affects the therapeutic process, goals, and treatment. Again, you must decide what is most comfortable for you in meeting your needs.
Enough time on your hands?
Therapy also takes time. You might find a “solution-focused therapist” that specializes in brief therapy, but when you add in time for assessment and discharge, you are still looking at 6 - 10 sessions. As I stated above, most therapy, for mild to moderate symptoms, lasts at minimum for 10 - 12 sessions. Thus, you need to be willing to make time in your life to come for therapy and to complete the work at home to make and solidify changes and get relief and grow. On average, you probably need to plan on coming weekly or biweekly for the first 2 - 3 months and continuing semi-regularly for 2 - 3 more months to get the full benefit. You might find relief quicker or may need much longer, but planning 4 - 6 months is a good estimation. This also means rearranging your schedule to make time. Finding a psychotherapist with open slots in evenings or on weekends is not easy! Getting creative and using your lunch hour, flex time, early mornings, or doing teletherapy may be necessary to coordinate with the psychotherapist you desire to see. Sadly, in this day and age, the mental health system is flooded, and you likely will have to wait patiently on a waitlist to begin therapy.
One of the positive advancements precipitated by our recent pandemic is the widespread access to telehealth. Though most psychotherapists would still prefer to see their clients in person, where privacy is more secure, body language is more apparent, communication flows easier, and emotional connection is more 3-dimensional, we have all learned to adapt to contact via screens (sad, but true). Teletherapy does open up people’s time and allow for more flexible scheduling for both providers and clients. It may help you to get help quicker and more conveniently, gives you access to psychotherapists throughout your state (not just in your 10 mile radius for travel), and may still be covered by your insurance, so consider your options.
Time is money. . . and money is valuable. . . and so is your mental health…
Think of it this way. How many times, when life gets overwhelming, and you feel anxious or depressed, and your job is stressful, and you are arguing more with your spouse, or your child’s behavior seems “out of control”, do you think or wish or decide, “I NEED TO GET AWAY!” and start planning a vacation? At those moments, the time and cost don’t matter as much because you are desperate to escape your problems and seek relief! Whether it’s a long weekend at a spa, a week in a cabin in the mountains, or 5 days on the beach, you find a way to afford it, make the time, and invest in your well-being. We all need that.
But, what happens when the vacation is over? Even on the ride or flight home, reality creeps back in and you start feeling the let down that life hasn’t changed. The problems and stresses and symptoms you tried to get away from for that brief time are waiting for you when you return.
What if instead of planning a “get away from my problems,” you planned a “get better and stay-that-way-cation?” It might not be as relaxing and freeing as a week away, but it might make the other 357 days of the year more enjoyable and less stressful. It might even make your worklife, marriage, and family healthier and make your home the place of refuge and escape you are seeking. Think of therapy as the means to create the real change that will last beyond your vacation days and might even make the years ahead much more fulfilling and satisfying. Perhaps this is the year to budget more money for therapy and less for vacation. When something is important enough to us, we always seem to make the time and find the money.
In sum, when choosing a mental health provider, you will want to consider the following practical matters. . .
How much does a session cost? More experienced and in-demand therapists often charge higher rates, but that doesn’t mean they will be the best fit for you. You need to consider what you are able to pay and how much you want to invest.
Does the psychotherapist offer a sliding fee scale?
If you want to use insurance and understand the need for a diagnosis and privacy risks, is the psychotherapist in your network? If not, will they give you a superbill to submit on your own so you can utilize your out of network benefits?
Do you have a health savings plan or flex spending account that you can access to pay for services?
Can you and the psychotherapist find a time that is consistent and fits within both of your schedules?
How long is the wait period to get started?
What does this therapist estimate will be your length of treatment (understanding that this is a “best guess” estimate based on the therapists' typical treatment of this issue with most clients; your circumstances and needs will be unique)?
Is teletherapy a good option for you, especially if the psychotherapist you desire to work with is not local?
Are you willing to commit to at least 4 - 6 months to solidify changes and experience lasting growth?
Who else will be involved in your sessions and does that alter the cost or length of treatment? Generally speaking, the more people involved, the more cost and time involved. Hence, marital and family therapy may cost more than individual therapy, but the lasting effectiveness for multiple people in a relationship can also be worth it!
What can you alter in your budget and schedule to make your mental health, marriage, and relationships better? Could long “walk and talk” dates replace dinners out? Could you hold off on home improvements to invest in relationship improvements? Could you work out at home instead of the gym for a few months? Maybe drinking less coffee or alcohol could help your mental health too!
At this point, you have your list of psychotherapists. You understand their qualifications, areas of expertise, and style. You have considered who you would fit best with, what you can afford, and if your schedules mesh. It’s now time to make the appointment and look over the contract.
