Ridiculous rules
I do not want to play by insurance companies rules, and I do not think anyone else should, either. Let's start with their rules about treatment. Insurance companies determine what type of therapy the therapist should use and for how long (about 10 sessions). Excuse me, did you go to school for 10 years to learn how to do psychotherapy?! This also leaves you, the client, powerless as to what type of therapy you get to do and for how long. Additionally, 10 sessions is simply not long enough for most people, especially for people who have experienced significant trauma(s). Sometimes it takes 10 sessions for someone to begin to feel safe in therapy. After 10 sessions, therapists have the option to "petition" the company and request more sessions (boo paperwork, more on that), but this petition can be declined. It seems re-traumatizing to me to begin treatment with someone and then have to stop treatment because a request for additional sessions might get denied. As an out-of-network provider, I love being able to collaborate with my clients regarding what type of therapy we do and for how long. I don't believe people should be in therapy forever, but when research repeatedly shows us that the quality of the relationship between the therapist and client is the best predictor of how well the client improves, then that relationship is worth spending the time to build.
Then there are ridiculous rules about being a provider for the insurance company. These rules include being subject to file reviews, contacting the company before referring the client to another provider, and being available for emergency situations. Seriously?! Why does the insurance company need to inspect your files? As a perfectionist, trust me, your files are upheld to federal and state standards, and no one else needs to skim through your file to verify that. And how is it a good idea to require providers to be accessible to clients for emergencies? A mental health emergency means someone is suicidal (planning to kill his/herself) or homicidal (planning to kill someone else) or detoxing from a substance; if this is occurring, the standard of care is to have the person go to an emergency room where the person can be provided 24/7 supervision. How the hell am I supposed to provide that? I can't.
Ridiculous reimbursement rates
Insurance companies only reimburse professionals 40-60% of their stated fee. Let's do the math. My fee is $125/hr, and let's say I get reimbursed at $60/hr and I see 25 clients a week (therapists don't see 40 clients a week for 40 hours because we need time for paperwork. We also don't get a paid lunch). And this assumes everybody shows up that week, which is unlikely, but we're trying to make this simple. This is only $1,500/week, $6,000/month, $72k a year. I know some of you are thinking, "Not bad, why is she complaining" BUT! Therapists then have to pay for self-employment taxes, their own vacation and sick days, business expenses, student loans, and professional fees (continuing education credits, organizational membership fees, license fees, business fees), which does not leave much of that $72k.
This also assumes insurance companies pay on a regular basis, which they do not. Providers sometimes have to wait MONTHS to get reimbursed. The insurance company can also change its rate at anytime without notice. How would you feel if you got paid irregularly by your employer? How would you like taking a random $10/hr pay-cut without reason? These hard truths of reimbursement leave many of my fellow colleagues bitter and resentful. Also, because the reimbursement rates are so low, providers have to take more clients to fill in the gap. It is easy to see how seeing increased clients can = decreased ability to provide adequate services = inefficient therapists = you, the client, not getting the help you need. By not taking insurance, I'm decreasing my risk for burnout, which means I can provide you with better services.
I do not want to play by insurance companies rules, and I do not think anyone else should, either. Let's start with their rules about treatment. Insurance companies determine what type of therapy the therapist should use and for how long (about 10 sessions). Excuse me, did you go to school for 10 years to learn how to do psychotherapy?! This also leaves you, the client, powerless as to what type of therapy you get to do and for how long. Additionally, 10 sessions is simply not long enough for most people, especially for people who have experienced significant trauma(s). Sometimes it takes 10 sessions for someone to begin to feel safe in therapy. After 10 sessions, therapists have the option to "petition" the company and request more sessions (boo paperwork, more on that), but this petition can be declined. It seems re-traumatizing to me to begin treatment with someone and then have to stop treatment because a request for additional sessions might get denied. As an out-of-network provider, I love being able to collaborate with my clients regarding what type of therapy we do and for how long. I don't believe people should be in therapy forever, but when research repeatedly shows us that the quality of the relationship between the therapist and client is the best predictor of how well the client improves, then that relationship is worth spending the time to build.
Then there are ridiculous rules about being a provider for the insurance company. These rules include being subject to file reviews, contacting the company before referring the client to another provider, and being available for emergency situations. Seriously?! Why does the insurance company need to inspect your files? As a perfectionist, trust me, your files are upheld to federal and state standards, and no one else needs to skim through your file to verify that. And how is it a good idea to require providers to be accessible to clients for emergencies? A mental health emergency means someone is suicidal (planning to kill his/herself) or homicidal (planning to kill someone else) or detoxing from a substance; if this is occurring, the standard of care is to have the person go to an emergency room where the person can be provided 24/7 supervision. How the hell am I supposed to provide that? I can't.
Ridiculous reimbursement rates
Insurance companies only reimburse professionals 40-60% of their stated fee. Let's do the math. My fee is $125/hr, and let's say I get reimbursed at $60/hr and I see 25 clients a week (therapists don't see 40 clients a week for 40 hours because we need time for paperwork. We also don't get a paid lunch). And this assumes everybody shows up that week, which is unlikely, but we're trying to make this simple. This is only $1,500/week, $6,000/month, $72k a year. I know some of you are thinking, "Not bad, why is she complaining" BUT! Therapists then have to pay for self-employment taxes, their own vacation and sick days, business expenses, student loans, and professional fees (continuing education credits, organizational membership fees, license fees, business fees), which does not leave much of that $72k.
This also assumes insurance companies pay on a regular basis, which they do not. Providers sometimes have to wait MONTHS to get reimbursed. The insurance company can also change its rate at anytime without notice. How would you feel if you got paid irregularly by your employer? How would you like taking a random $10/hr pay-cut without reason? These hard truths of reimbursement leave many of my fellow colleagues bitter and resentful. Also, because the reimbursement rates are so low, providers have to take more clients to fill in the gap. It is easy to see how seeing increased clients can = decreased ability to provide adequate services = inefficient therapists = you, the client, not getting the help you need. By not taking insurance, I'm decreasing my risk for burnout, which means I can provide you with better services.
I HATE paperwork
Insurance companies
require therapists to
provide them with
treatment summaries of
what they do in session with the client and any other
paperwork they desire. I
feel this paperwork is
unnecessary and really
none of their business. I
have to complete session notes and other related documentation to maintain your record, and that is enough to keep up with as is!
More time doing paperwork = decreased time with clients = unhappy therapist = unhappy clients. I love being able to spend more of my time in therapy with clients, which is what I am
passionate about.
Insurance companies
require therapists to
provide them with
treatment summaries of
what they do in session with the client and any other
paperwork they desire. I
feel this paperwork is
unnecessary and really
none of their business. I
have to complete session notes and other related documentation to maintain your record, and that is enough to keep up with as is!
More time doing paperwork = decreased time with clients = unhappy therapist = unhappy clients. I love being able to spend more of my time in therapy with clients, which is what I am
passionate about.
Due to some unethical insurance rules, therapists are often forced to be unethical in order to provide services
Insurance companies will not cover therapy if a person does not have a mental health diagnosis, but they also will not cover therapy for certain diagnoses (absurd, I know). This forces therapists to make inaccurate diagnoses in two ways, which is unethical and feels yucky. The first is to record diagnoses for clients whose concerns do not warrant a diagnosis so clients can receive coverage for their treatment, which then becomes part of their health record. Think about the implications that could have for your life insurance policy or career. Or, someone may have a diagnosis that the company will not cover therapy for, so the provider leaves that diagnosis out of the clients' record, which would not be helpful to future providers should the person need a referral. In my practice, my clients can rest assured knowing their protected health information is accurate and that only people with access to their information is me and them.
I have been strongly advised not to take insurance
My residency supervisor has a very successful private practice. However, she told me that, given the chance to do it all over again, she would choose not to take insurance and she would have a fee-for-service private practice only. I have also received similar advice from other professionals who are very successful and do not take insurance. That's really inspiring to me.
I'm excited to see what the future holds for my practice and my clients. I'm not sure I could say that if I were working for insurance companies who were irregularly paying me and I was burning out from seeing 35+ clients a week and doing 20+ hours worth of paperwork. Are you a mental health consumer who sees a therapist who does not take insurance? Are you a provider who maintains a fee-for-service practice? If so, I would love to hear from you!
]]>Insurance companies will not cover therapy if a person does not have a mental health diagnosis, but they also will not cover therapy for certain diagnoses (absurd, I know). This forces therapists to make inaccurate diagnoses in two ways, which is unethical and feels yucky. The first is to record diagnoses for clients whose concerns do not warrant a diagnosis so clients can receive coverage for their treatment, which then becomes part of their health record. Think about the implications that could have for your life insurance policy or career. Or, someone may have a diagnosis that the company will not cover therapy for, so the provider leaves that diagnosis out of the clients' record, which would not be helpful to future providers should the person need a referral. In my practice, my clients can rest assured knowing their protected health information is accurate and that only people with access to their information is me and them.
I have been strongly advised not to take insurance
My residency supervisor has a very successful private practice. However, she told me that, given the chance to do it all over again, she would choose not to take insurance and she would have a fee-for-service private practice only. I have also received similar advice from other professionals who are very successful and do not take insurance. That's really inspiring to me.
I'm excited to see what the future holds for my practice and my clients. I'm not sure I could say that if I were working for insurance companies who were irregularly paying me and I was burning out from seeing 35+ clients a week and doing 20+ hours worth of paperwork. Are you a mental health consumer who sees a therapist who does not take insurance? Are you a provider who maintains a fee-for-service practice? If so, I would love to hear from you!
I have actually never seen the show Intervention on A&E. My understanding of the show and what is a drug/alcohol intervention: A group of family members and a professional get together to confront a loved one about their addictive behavior and try to get them into treatment. The family and the professional usually try to force the person into treatment through ultimatums or some other coercive action.
First, let's talk about the word "intervention" to clear up confusion because it has a different meaning to mental health professionals. For psychologists and licensed counselors, an intervention is either a type of therapy, or a component of a therapy, that is intended to bring change to a persons' mental health functioning. In the psychology world, someone would asked me, "What interventions are most helpful for people with drug and alcohol problems?" and my response would be, "One intervention that is effective for people with drug and alcohol problems is Rational Emotive Behavioral Therapy (REBT)," or, "Helping clients change irrational beliefs about their drug use," which is a more specific intervention that is a part of REBT. So if you call and ask me to do an intervention with your loved one, my brain says, "What type of intervention are you talking about? The A&E-style intervention or an intervention that is really therapy and backed by research?"
Second, I was not trained in school or through continuing education courses to do the A&E-style intervention, and I am not going to provide a service I am not trained to do. I do not know any mental health professionals who are actually trained in and provide these types of interventions. Please let me know if you are one! Furthermore, I have heard that when these interventions occur in real life, catastrophes can happen, such as the person with the addictive behavior storming out, getting high, and overdosing. Ain't no way in hell I am going to be a part of that.
Third, we have to remember that reality TV is not real. I am not going to invalidate the shows' participants and their experiences, but we have no way of knowing what is true and what is fabricated by producers for ratings.
Fourth, forcing someone into doing something and giving ultimatums rarely works and rarely produces long-term change.
Third, we have to remember that reality TV is not real. I am not going to invalidate the shows' participants and their experiences, but we have no way of knowing what is true and what is fabricated by producers for ratings.
Fourth, forcing someone into doing something and giving ultimatums rarely works and rarely produces long-term change.
So how do you get a loved one into treatment? Here is what you can do:
1. Do your research before you confront the person. There are usually several facilities and providers in your area that offer drug and alcohol treatment, including residential care, detox services, and outpatient services. Outpatient services may include individual therapy, group therapy, or both. Check local churches who sponsor AA, NA, and other 12-step meetings. Recovery.org is a great site to discover local treatment options. SMART Recovery, an organization with a non-12-step approach to recovery, also provides valuable information about addictive behaviors and how you can support someone in treatment.
2. Pick a time to talk with the person. A simple, "I have something on my mind I would like to talk with you about. You are not in trouble. When can we talk?" will work. This way the person does not feel backed into a corner and has a choice when, whether, and how to respond to you.
3. Assert yourself in a non-blaming, non-judgmental way. This part is so important. Do not call the person names or labels such as druggie, addict, loser, deadbeat, etc. "I" statements work wonders here. Convey a tone of curiosity.
"I found X drug/needles in your car/clothes/room. I would like to know more."
"Call me paranoid, but I have this suspicion about your drug/alcohol use. I'm wondering if you have been using X or drinking more than usual."
"I have noticed you have lost/gained a lot of weight recently, and I'm worried about your health since you started using/drinking."
4. Make this a "we" problem. Let the person know you are in this together with them. Ask, "What can we do to get you clean and sober?" For more ideas on how to start a collaborative conversation, click the link for an awesome user-friendly guide of Motivational Interviewing techniques.
5. Give them options. "There are several places and people that help people with addictive behaviors. Would you be willing to check any of them out?"
"I found some information about places that help people with addictive behaviors. I will leave this here for you to read."
6. Accept that they may not own up to their drug/alcohol use and go into treatment. If your loved one is not concerned about their drug/alcohol use, then they are not going to get help. If this person is an adult you cannot force them into treatment. If your response to this is, "How do I make them see they have a problem?" remember you cannot make anybody do anything. You can influence someone, but ultimately that person has to come to their own conclusion that their use is a problem. Make a plan of action beforehand and discuss what you are going to do and not do if the person decides not to seek help at this time. Remember that just because they are not seeking help today does not mean they will not seek help tomorrow. Be prepared to follow through with an ultimatum if you are going to give one. Do not threaten to kick your loved one out of the home if you cannot face the fact that this will leave them homeless.
7. Seek therapy for yourself. I love working with the families of people with addictive behaviors just as much as I love working with people with addictive behaviors. You may be feeling stressed, betrayed, let down, ashamed, and like an awful spouse/parent/sibling/daughter/son. Having a positive support system is paramount for your loved ones' recovery, and it will be hard for you to provide that support if you are operating from a place of hurt, disgust, and shame.
1. Do your research before you confront the person. There are usually several facilities and providers in your area that offer drug and alcohol treatment, including residential care, detox services, and outpatient services. Outpatient services may include individual therapy, group therapy, or both. Check local churches who sponsor AA, NA, and other 12-step meetings. Recovery.org is a great site to discover local treatment options. SMART Recovery, an organization with a non-12-step approach to recovery, also provides valuable information about addictive behaviors and how you can support someone in treatment.
2. Pick a time to talk with the person. A simple, "I have something on my mind I would like to talk with you about. You are not in trouble. When can we talk?" will work. This way the person does not feel backed into a corner and has a choice when, whether, and how to respond to you.
3. Assert yourself in a non-blaming, non-judgmental way. This part is so important. Do not call the person names or labels such as druggie, addict, loser, deadbeat, etc. "I" statements work wonders here. Convey a tone of curiosity.
"I found X drug/needles in your car/clothes/room. I would like to know more."
"Call me paranoid, but I have this suspicion about your drug/alcohol use. I'm wondering if you have been using X or drinking more than usual."
"I have noticed you have lost/gained a lot of weight recently, and I'm worried about your health since you started using/drinking."
4. Make this a "we" problem. Let the person know you are in this together with them. Ask, "What can we do to get you clean and sober?" For more ideas on how to start a collaborative conversation, click the link for an awesome user-friendly guide of Motivational Interviewing techniques.
5. Give them options. "There are several places and people that help people with addictive behaviors. Would you be willing to check any of them out?"
"I found some information about places that help people with addictive behaviors. I will leave this here for you to read."
6. Accept that they may not own up to their drug/alcohol use and go into treatment. If your loved one is not concerned about their drug/alcohol use, then they are not going to get help. If this person is an adult you cannot force them into treatment. If your response to this is, "How do I make them see they have a problem?" remember you cannot make anybody do anything. You can influence someone, but ultimately that person has to come to their own conclusion that their use is a problem. Make a plan of action beforehand and discuss what you are going to do and not do if the person decides not to seek help at this time. Remember that just because they are not seeking help today does not mean they will not seek help tomorrow. Be prepared to follow through with an ultimatum if you are going to give one. Do not threaten to kick your loved one out of the home if you cannot face the fact that this will leave them homeless.
7. Seek therapy for yourself. I love working with the families of people with addictive behaviors just as much as I love working with people with addictive behaviors. You may be feeling stressed, betrayed, let down, ashamed, and like an awful spouse/parent/sibling/daughter/son. Having a positive support system is paramount for your loved ones' recovery, and it will be hard for you to provide that support if you are operating from a place of hurt, disgust, and shame.
For additional help and information about addictive behaviors, check out my Books I Love section. I have seen so many people with addictive behaviors change their lives around, and I wish you the best in your and your loved ones' recovery. Please feel free to email me or call me if you would like my assistance in your recovery journey.
However, it's possible I might break my resolution, and I'm wondering if any of you have broken your resolutions yet. Here are some ways to get yourself back on track:
1. Take responsibility
Maybe you're still in denial about how much you broke your resolution. Breaking it is breaking it, even if it's "just a little bit." Admitting you broke it is the first step forward to your desired outcome.
2. Redefine your goal(s)/value(s)
Why are you doing this? What are you hoping to achieve? How will keeping this resolution make you a better person? Is your resolution realistic?
3. Recommit yourself
Start over now and work toward your end goal now. Share your resolution with someone to further define your accountability.
4. Forgive yourself. Over and over again.
It takes time to kick bad habits and replace them with effective ones. Be patient with yourself and be persistent.
I would love to hear about your resolutions in the comments below!
]]>1. Take responsibility
Maybe you're still in denial about how much you broke your resolution. Breaking it is breaking it, even if it's "just a little bit." Admitting you broke it is the first step forward to your desired outcome.
2. Redefine your goal(s)/value(s)
Why are you doing this? What are you hoping to achieve? How will keeping this resolution make you a better person? Is your resolution realistic?
3. Recommit yourself
Start over now and work toward your end goal now. Share your resolution with someone to further define your accountability.
4. Forgive yourself. Over and over again.
It takes time to kick bad habits and replace them with effective ones. Be patient with yourself and be persistent.
I would love to hear about your resolutions in the comments below!
There are so many blog posts and store displays advertising "5 Gifts She'll Love" or "The Best Gifts for the Golfer (or whoever) in Your Life." But you know what the best gift is? Your time. Seriously. The times we share with loved ones are more etched into our memories than the gifts we've exchanged with them.
This holiday season, I invite you to do something different. I invite you to put down your phone, your tablet, or your iPad. Turn off the TV, leave work early, clean the bathroom tomorrow. Tell Facebook world and the laundry to wait. There is nothing more important than spending time with someone you love. Take 10-15 minutes (or longer!) and direct your attention toward someone and something worthwhile. Or, maybe there's someone you're not getting along with and you would like to make amends or maybe there's someone you need to forgive. Before this year is up, I challenge you to connect with someone in a meaningful way.
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