Updated August 04, 2006

Navigating Mental Health Care

by Joseph B. Nelson, M.A., L.P.

If you go to see someone in private practice, the fee structure will likely depend on the practitioner’s profession and training. Some therapists accept insurance, and some do a cash-only business. Those who do a cash-only business are likely to provide a receipt with which you can file your own insurance claim. Some therapists are willing to negotiate their fees, particularly if they do a cash-only business, so if you can’t afford their full fee it can’t hurt to ask them for a discount that would better fit your budget. If they are not willing to negotiate, they can at least help with a referral to another therapist who charges less.

Unfortunately, maintenance for upkeep of your ship isn’t always paid for by insurance. But even if your insurance doesn’t reimburse you for sessions with certain mental health professionals, the training and experience that a therapist has to offer may convince you to seek help from him or her anyway. For example, most insurance companies do not pay for marriage counseling or sex therapy, both of which deal with very important areas in adults’ lives. In these cases, therapy dollars are often well-spent on a specialist who can help steer you through some hard times.

When—and how often—will I go?
Limitations on the number or frequency of therapy sessions you can have each year depend on a few different issues. The first issue is the availability of the therapist. In some centers, therapists are so busy that patients must wait a long time for an initial consultation and then often cannot return for an extended period. This common frustration is generally caused by the system, not the therapist. Another limitation is the time of day of session availability. Many settings offer sessions only during daytime hours. Since people often work during those hours, this can make seeking help more difficult.

The last issue is the insurance company’s limitations on the number of psychotherapy sessions you can have. In most instances, the number of sessions is approximately 30 per year. This works out to one session about every other week, with a few weekly sessions during the initial assessment period. For most psychotherapy, this is an adequate number of sessions for effective therapy. If, however, the severity of your condition requires a greater frequency of appointments, this can usually be arranged through a request for additional sessions by the therapist.

What’s the plan?
The plan that you and your therapist develop will help you to understand how therapy works. This is a collaborative relationship. Effective communication between you (the captain) and your therapist (the navigator) is a joint effort. Formulating a plan of action will also help you to get an idea of the pacing of the sessions and of the process in general.

Your plan is intended to be a general guideline. Your progress in psychotherapy depends upon how each session goes, and is affected by how well you do the homework and by your ability to implement change in your life. Your part in this process is key—it is important that you be honest with your therapist and be invested in getting better.

Most people would say “Of course I want to feel better,” but the process of feeling better often means facing some difficult truths and making changes in our lives. This is where the concept of hard work in therapy comes from. To make the most of your therapy, then, it is critical that you do your part both in and out of sessions. Homework may involve specific tasks, such as speaking with a family member about a problem, or activities, such as keeping a daily journal. Make sure that you are clear on homework assignments, and that you are willing to do them. If you don’t understand or are not willing to do the homework, tell the therapist so that you can come up with an assignment that will work for you.

Taking the first step
When people are depressed or anxious, they often find it difficult to think about setting sail for any destination outside their comfort zone. Seeking therapy can be like venturing into uncharted waters, and fear of the voyage may be the greatest obstacle to making the call to seek help. Motivation may come from knowing that you are not available to your loved ones the way you want to be, or from having someone who cares about you notice that you are down. Still, for some people, the most difficult part of the process is just making the decision to ask for help. It requires not only courage, but energy, and those who are depressed often don’t have that energy. In some instances, a loved one might make the first call for you or help do the initial legwork involved in finding a therapist. Another option is to discuss your situation with your doctor or diabetes educator to see if one of them can help you get connected with a therapist. Most of the time, these options work well and can help you make that important initial contact.

Joseph Nelson is a psychotherapist in private practice in Minnesota.

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