Friday , August 6 2021

How to find – and pay – a therapist

Photo by Logan Cameron (cropped) on Unsplash.

As a therapist, I would like to stress that in every first session the effort the patient has made to enter therapy in the first place. I know that getting into therapy requires effort because it's part of my daily conversations with people in my personal and professional life. Recently a family member sent me a message saying, "If I had a friend who was having panic attacks, what should that friend do? There are apps that will help you?" I received this message the day after that I answered a client's email that I saw as a student at my university's counseling center: "How can I find a therapist I can afford with my internal salary? My parents' insurance is out of the network I live in now. "Almost every week the patients in the hospital where I am training tell me they waited over six months in a waiting list to see me because they could not find anyone else who would take their insurance – and that's all before the real treatment work begins.

I know the research on the benefits of therapy, yet when I had to find a therapist I found myself wondering if retail therapy, cat petting or Netflix marathons did not work. It can be so hard to find someone you can afford, sometimes you work for yourself, which makes things better instead of worse. The good news is that it is possible; the bad news is that it can be complex. To demystify the process a bit, I tried to answer common questions from my point of view as a therapist, graduate student and a person who is concerned with access to mental health care.

Question 1: How can you afford a therapist?

  • Do you have an insurance?
    • Yes, and I know how to use it
      • I am always impressed / jealous of people who have a good understanding of their insurance. If it is you, then your next step is probably to choose a supplier from the list that the insurance company or the general practitioner gave you. See question 2 for suggestions.
    • Yes, but I do not know how to use it
      • The first step is to understand the terms of your insurance. Call your insurer (this number is often found on the back of your insurance card) and ask if you have session limits, a deductible and a co-pay. Also ask what types of mental health services are covered (ie test, group therapy, couple or family therapy), the number of sessions covered per year and if they have a list of counseling providers (preferred suppliers) that you have to choose from for the insurance plan to provide maximum coverage. If they have a list, use it; otherwise, you can check or other listing sites and order by insurance company. If you have a therapist that you want to try but is not covered by your insurance or is cash only, ask if the therapist does "superbugs" that give insurers the information they need and can allow you to get a refund from the doctor. insurer.
    • No, or yes, but for some reason I can not use it
      • Are you a student?
        • If you are a student at a college or university it is very likely that counseling is included as part of those assorted fees added to your line. Search for your school's counseling center; you will probably have access to at least some free sessions and free referrals and other services like crisis drop-in sessions and therapy groups.
      • Do you have an employee assistance plan?
        • Many employers, especially large companies, have employee assistance plans (EAPs) which, as employees, have free access. These EAPs usually give access to several free therapy sessions, case management and referrals to other services. The human resources department can provide you with more information about your EAP.
    • Can you afford to pay something out of pocket?
      • Yes, I can afford a full rate
        • The full rate offers you many options, which can be overwhelming. See question 2 if you want directions on how to choose the best option.
      • Yes, I can afford something but not the full price
        • It could be a good measure for sliding scale fees. Many therapists keep one or two of their slots for customers on the escalator. The amount you pay is based on what you can afford, within a range of the therapist's usual rate. For example, a friend who charges $ 100 per session offers a sliding fee of $ 50- $ 70 per session. The downside is that these points can be hard to find as they are not always advertised or open.
        • Another university option is the other good option. Many universities with graduate training programs in mental health fields run clinics to help their students gain experience. These students have taken fundamental courses and are supervised by licensed professionals. Training clinics can also be a way to afford a service insurance that can not cover, such as couple counseling or family therapy. You can find the training clinics looking for the name of your local university and the "training clinic", or you can call the university psychology department and ask to be referred to the right place. I have seen that the frequency of training courses varies from totally free to $ 70 per session, and there may be an escalator.
        • Other suggestions include asking the therapist if it is possible to switch to biweekly instead of weekly sessions. You can also look for associate therapists, who are graduates and have temporary licenses but need more supervised hours (or to pass the licensing exam) to get their full license. They are often building their practice, so they tend to offer lower rates and have more openings.
      • No, I can not afford anything now
        • Probably there is a non-profit in your area that specializes in social services. There is probably also a community mental health center that accepts low / zero income clients. Search for your city / country and terms such as "therapeutic cooperative", "human services" and "community counseling". They can offer free individual therapies, free groups, or have references to other opportunities. You can also check out your local university clinic, which can offer free sessions.
        • As a stop-gap until you find a free therapist or your financial situation changes, here are some things you can do that could help you. Professional therapy can not be replaced when necessary, but this does not mean that help can not be obtained elsewhere. There are applications that can show you the basics of self-help for sleep problems, depression, anxiety, etc. Those that I recommend to clients are What's Up for Symptoms of Depression and Anxiety, Wyza for Relaxation / Calming and Mindfulness Coach for Introductory Awareness. The 7 Cups of Tea website offers trained "listeners", which can be useful if you need a non-judgmental ear. An old school option is to take a look at some of the great books of bibliotherapy or self-help in your library. I like it The Worry Cure by Robert Leahy for anxiety and Get out of your mind and your life by Stephen Hayes for depression.

Question 2: Do you know what kind of therapist you want to see?

  • Yup
    • Is fantastic! I hope you will soon find a great therapist. What you should do is figure out what payment options you have, then review the next steps described in Question 1.
  • No, I do not even know where to start
    • The most important thing to know is that most of the therapists are trained to help with most mental health problems. We have a research that supports the idea that most of what works in therapy is the relationship between therapist and client. Start figuring out your payment options and then search for Yelp reviews, ask your friends, ask your primary care physician, or simply choose someone close to you geographically. Once you've identified a potential therapist, you can ask them why they think they would be right for you. Many private practice therapists will make a free phone or in-person consultation session to see if you are suitable for them and vice versa. If you start therapy and it does not work for any reason, you have the right to ask the therapist to refer you to someone else. Requesting a referral can be inconvenient, but it is not uncommon and the therapist will not feel offended.
  • No, but I know I have a specific concern (eating disorder, substance use disorder, psychosis, relationship problems, parenting problems)
    • If you know that you need someone who has specialized training for certain conditions and populations, then you will want to identify the type of training you are looking for. Unfortunately, especially in private practice, some therapists say they can work with anything and anyone – which is usually not the case. Search for therapists who list exactly what type of training / experience they have; for example, a feed disorder disorder specialist (CEDS) is a more consistent standard than a weekend seminar on eating disorders ten years ago. For psychologists, anyone with ABPP after their name indicates a board certification in a specialization area such as neuropsychology or family psychology. Find outreach groups for your concern and look at what certifications or training courses they recommend.
  • No, but what are some good things to look for?
    • For people seeking therapy for the first time, especially when their concerns are related to depression or anxiety, I usually recommend that they seek out a therapist using a cognitive behavioral approach (CBT). CBT is the gold standard for many conditions and is generally short-term. With CBT you will not spend many days a week for ten years on a sofa, so it's cheaper. Another thing to look for is someone who does not pretend to work with all conditions of A-Z for pediatrics through geriatrics. Generalists are completely normal and satisfying, but it is a red flag if someone says they specialize in many things or practice any type of therapy.
  • No, because I'm so confused about the difference between all grades and licenses
    • I spent a lot of time explaining to my mother, to people on planes, and to me the differences between all degrees / licenses of mental health. The short version is this: psychiatrists I'm MD who can prescribe drugs. It is increasingly rare that they offer language therapy. psychologists they are PhDs with advanced training in diagnosis, assessment and treatment, especially for serious mental illnesses. If you need testing for something like ADHD or autism spectrum disorders, a psychologist is what you should look for. There are also many types of therapists who have a degree; for example, clinical social workers, mental health counselors and marriage and family therapists. All of these therapists are trained to work with a range of concerns, but with slightly different goals on how they think about diagnosis and treatment. Licenses vary by state, so consult your state's health department for specifics.

Question 3: C & # 39; is anything else that prevents you from taking that appointment?

  • No, I'm setting an appointment now
    • Fantastic, that can be the hardest part of the whole process. Good luck!
  • Yes, I can not find a time that works for me
    • Try university training clinics and private professionals (especially colleagues) for a wider variety of hours than most of the associated health service providers.
  • Yes, but it is super-specific
    • The website of Administration of Substance Abuse and Mental Health Services ( is an excellent resource for getting more information on this. I am also happy to deal with things from my personal point of view in the comments.

Melissa Caris is a therapist and graduate student who is happy to have the opportunity to write something without abstract or in-text citations. He lives in Seattle with her husband and two cats.

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