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My Totally Unofficial 2024 Guide to Therapy, Part 1

Updated: Dec 31, 2023


Nuts and Bolts: Finding a Therapist and Paying for a Therapist


So, you’ve decided that it's time to work on yourself/work on that relationship/maybe see if life just might be a little better. Where do you start when looking for a therapist?


Therapist directories

Don’t bother with the directory from your insurance company. There’s a good chance that it's outdated, plus all you get is a name and address. There are online directories, however, that will give you a chance to get a feel for the therapist. The most popular one is on the Psychology Today website. Others include Therapy Den and Good Therapy .


The Open Path Collective lists therapists who have agreed to offer a sliding scale fee. You can read about one person’s experience with it here.


Doctors and/or Faith community leaders

Primary care doctors and leaders of faith communities (for example, pastors, priests, or rabbis) often keep lists of therapists to whom they refer people. Through the years I’ve had many primary care doctors refer to me when their patients have come in complaining of anxiety or depression. If you don't want to be specific about what you need, you can just tell them that you're thinking about therapy and ask if they have a recommendation. 


If the leader of your faith community has a healthy respect for the therapy process, they can also be a good source. Be wary, however, if they are advocating treating emotional difficulties just with prayer and Bible reading.


In addition to being a licensed counselor, I’m also an ordained minister. Sometimes faith is a part of the conversation. Sometimes part of the work is healing from toxic and abusive experiences in faith communities. 


Faith doesn’t exclude solid emotional and psychological work. If the spirit’s healing work can come through the doctor who sets a broken bone and applies a cast, why can it also not come through a well trained therapist?


Trusted friends

You may have friends who have mentioned their own therapy. Ask them who they saw and what they liked/didn’t like. You can also ask friends if they have heard other people talk about someone who was really good.


What about all of these new apps I hear advertisements for, the ones who promise cheap therapy via texting, phone, or video?


First of all, this article is a good window into how these companies use client data. 


Secondly, as tech start-ups they promote practices that might work for their bottom line but in reality work against a client making progress in therapy.  For example, part of their sales pitch is that your therapist is “always available.” Here’s why that’s a terrible idea. 

 


I called/emailed a therapist  but they didn't get back to me.

It happens. Yes, it shouldn’t happen but sometimes it does. 

In my younger years sometimes I failed to call someone back because the message wasn’t clear on my voicemail. I remember playing messages back four or five times unsuccessfully trying to decipher a number.


Of course, now with cell phones we can see the number. However, sometimes I still cannot call back because I cannot hear the name clearly. I don’t know who to ask for. Why don’t I just call and say someone called me from this number? Because that breaks confidentiality. 


I don’t know if it’s a private cell phone number. I don’t know if the people in their life know that they are starting therapy. I don't know if it is safe for family to know or if an issue in this person’s life is a controlling family member. So, don’t assume I’ve caught your name. Say it twice. Spell it out.


If you've called or emailed someone with whom you’re really interested in working and haven’t heard back, it’s worth it to give it a few days, then reach out again. 




So perhaps you’ve found someone. How do you pay for it?


Insurance

Before your first session, call to verify your benefits and any copay you may have. If you have a large deductible, you will have to pay the full insurance contracted rate, which probably isn’t the cash rate listed on the therapist’s website. Ask specifically about coverage for outpatient mental health and how the insurance company handles that. 


Why? Let me introduce you to the carve out.


You may have insurance with Insurance X. Your plan states that you have coverage for outpatient counseling. Great!


Except it turns out that Insurance X doesn’t actually handle any mental health claims. That’s carved out and handled by Insurance Y. The therapist who is in network for Insurance X may not be in network for insurance Y.


Not so great.


Which leads me to asking about out of network coverage. Some plans will reimburse you part of the cost if you submit something called a Superbill (provided by the therapist) while others pay nothing.


Self pay/sliding scale


If insurance isn’t an option, then you're looking at paying out of pocket. Some therapists will offer sliding scale options for clients in need, or may have a limited number of sliding scale spots. Where I live, there are some very good group practices that employ Counselor Associates. 


These are people who have completed all of their schoolwork and are now accumulating their required number of hours of clinical work that they must have in order to sit for the licensing exam. (It’s a large number of hours.) These therapists all practice under the supervision of a licensed supervisor and will offer reduced fee counseling. 


A therapist may be willing to work with you to create a counseling schedule you can afford; for example, a session once a month instead of once a week with lots of homework to work on in between sessions. It’s always worth asking.


Also, take a realistic look at what you might be willing to forgo for a while as you invest in yourself. Do you need a latte every day? Can you cut back on a streaming service? Do you really need to buy that book? (Ouch! That one hits home for me!) Can “necessary” things become optional - at least for a while?


Therapy is an investment in yourself and your future. The ripple effects extend out to your job as well as relationships with family and friends. I have seen clients make changes that significantly improved their lives. And I’ve seen clients make changes that weren’t earth shattering but still made their lives easier or more satisfying. Occasionally I get a note from a former client telling me how they are still using the tools they discovered in therapy and the difference they make.


Before you decide it can’t be done, explore all of the ways in which it might be done.


Next time we’ll look at what to expect and how to work with a therapist (including what therapists should never do.)


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