Picture this scenario: You are in the market for a car, and you know that you’ll need to finance it somehow. You go to your bank, tell them you need their help with buying a car, and in response the loan specialist at the bank hands you a booklet entitled: “These are the cars we’re willing to help you finance. Otherwise, you’ll have to pay for the whole thing yourself.” Catchy title, isn’t it? So you go home, sit down and read through the booklet and pick one of the ten cars listed so that you can receive financing from the bank. It’s not the car you had in mind, it’s the wrong size and color and it doesn’t have a roof rack for your canoe. But it’s on the list so you have no choice but to buy it. Right?
I don’t think so. We all know that this is a messed up way to go about getting a car. Yet this is how many people end up with the psychotherapist they go to.
Many psychotherapists sign a contract with an insurance company in which they promise to adjust their charges according to what the insurance company thinks is “reasonable.” In return, the insurance company puts them on their list of “providers” who “provide” the service of psychotherapy. (And what is that, anyway? Read the blog “What a Good Psychotherapist Does.”) What many people then do is find the “provider” who is most conveniently located, and make an appointment.
What most people don’t know is that being included on an insurance company’s list of “providers” says nothing at all about how well the psychotherapists on that list are trained, or the quality of treatment they “provide.” The only guaranteed detail is that the psychotherapist holds a valid license in your state. Furthermore, many insurance programs put strict limits on how long a session will be and how many sessions you can have before the insurance runs out. For example, in some programs you find yourself covered for only twenty sessions.
Those of us at IIGP, most having practiced in this field for 35-40 years, know that the best that the patient can receive in twenty sessions is temporary relief from anxiety or some advice. After their insurance limit runs out, many people then leave “psychotherapy,” believing that it can’t help much, and end up relying on medication. Sometimes people are even told that they have a “chemical imbalance” like diabetes and will need to be medicated for life. This is true for only a small handful of disorders. The rest of the time this claim is pseudo-science that has no research to back it up.
So here’s the straight talk. If you want to get good psychotherapy, talk to as many people as you dare to talk to about your search for a good therapist. DON’T bring money into it, because you’ll pre-reject some of the best therapists in town. Find the therapist you hear has really helped people change their lives. If a therapist can help someone actually change his or her life, rather than just learn how to get over the current crisis, then chances are s/he’s at least a pretty good therapist. I would suggest making an appointment with someone like that, rather than someone on a list.
Don’t ask about the fee. If he begins by telling you his fee and asks you if you can pay it, you got a bum steer. A good therapist is willing to consider a temporary fee reduction so you can at the very least get to know what quality psychotherapy is like. Go at least three times, even if it costs a fortune. We’re talking about the quality of the rest of your life here, not buying a luxury car.
Good therapy can be like paying to get through a university degree program, but it’s even more important because it will affect how happy and satisfied you’ll be in the years you yet have to live. A good therapist will understand your financial difficulties and help you find a way to do it.