So, Who Might See a Counselor? (Hint: Everyone!)
I'm convinced that absolutely everyone can benefit from mental health counseling, they just have to be open to it. I have a hero, and though I technically do not know precisely who he is, my hero he remains. The story goes something like this: a few years ago, a friend and I were talking (I don't remember which friend it was) and my friend said that his dad had recently told him that he (the dad) had started seeing a counselor. My friend said, "But Dad, why? You're not 'disturbed.' You don't have any mental health issues..." His dad said, "Well...I've taken leadership courses to learn how to be a better manager. I've gone to school to become more qualified in my field. I decided I wanted to learn more about myself and my emotions by speaking with a counselor. Why would I miss out on an opportunity to grow?"
Yes! So my friend's dad, whoever you are...I appreciate you. You are wise and I tell your story to many people.
Sometimes you may find that you have more obvious reasons that you may want to see a counselor: perhaps you are struggling with an addiction or an eating disorder; perhaps your marriage or relationship is falling apart and you want to try to save it; perhaps you are in the military and you've seen some terrible things that are causing you to have flashbacks or are disturbing your sleep; perhaps you are feeling depressed, disconnected, and lonely.
But beyond that, you may find that you have less obvious reasons that you may want to see a counselor: perhaps you would like to learn to be a better listener and a better communicator in your relationships; perhaps you want to increase your emotional intelligence, your self-awareness, and your awareness/understanding of others; maybe you don't know how to communicate your needs and ask for them to be met in a healthy way (related: maybe you don't even know that you are worthy of having your needs met!); maybe you feel like you're more sensitive than everyone else and you wonder if something is wrong with you. (Side note for highly sensitive people, or HSPs: your sensitivity is a gift. I'll write an article with more about this soon.)
In short, as I said earlier, it's my professional opinion that everyone can benefit from talking with a counselor. We just have too many stresses in this life, and too little emphasis on reflecting within and getting to know ourselves, that it's resulting in us being (at best) ignorant, and (at worst) trying to cope with the natural stresses of life through substances, sex, affairs, self-deprecation, self-hate, denial, perfectionistic thinking, constant people-pleasing and denial of our self, having a lack of boundaries, and more.
One of my passions is to fight the stigma that sometimes still exists around receiving mental health help, which includes seeing a counselor, going to psychiatric hospitals, taking psychotropic medications (such as anti-depressants), going to programs such as residential treatment or partial hospitalization for things such as addictions or depression, and anything else that you would consider helpful in taking care of your thinking and feeling self. One piece of good news is that cultural stigma, at least in the United States, has been decreasing in recent years and is continuing to decrease. (The bad news is that the rest of the world is kind of behind the U.S., but we can all help little by little to diminish stigma there, too.) This is where my beef comes in: aren't we, as people, mostly our internal, intrapsychic processes such as our thoughts, our feelings, and our inner motivations that cause us to behave the way that we do? And then isn't all of that amazing stuff, like a gift, wrapped up in the (also awesome) box/wrapping paper/bow of our outer, physical selves? At this point in history, we will we do anything and everything to take care of our outer gift wrap (i.e., our bodies), be commended for doing things that keep that gift wrap in tip-top condition, and be shamed for not doing the things we can to keep that gift wrap in order. ...So if the gift wrap gets this much attention and honor, then why on earth are we not paying just as much attention (or more!) to the actual gift that is the main event on the inside?! Why do we focus less on our inside main event (i.e., our inner selves), talk less about how to care for our inside main event, and even feel ashamed if we need help with our inside main event?? I say forget that. I think that mentality is just wrong and illogical, so I've dumped it and instead I have chosen to value and honor all the inside stuff, both mine and yours. And when I need help with my own inside stuff, I get it. Because I'm taking care of one of the most precious things I have...my inner self.
How Does Counseling Help? Why Does it Work?
Coming soon. This article is still under construction.
My Own Story
My parents divorced when I was young and my father suddenly passed away when I was a teenager. My family and I knew little about the world of counseling, so I never received professional counseling help at the time of those difficulties. Unfortunately, since I never fully processed and healed from these traumas, my emotional difficulties came out in the form of a severe bulimic eating disorder when I was in college. My mom noticed I was making a lot of calls home completely obsessed with diet, exercise, and body image, and she lovingly booked me an appointment with a counselor, saying that I did not have to go but that the appointment was available to me if I wanted it.
I didn’t think I needed counseling (at that time I mistakenly thought only “crazy” people needed counselors...now I know that everyone should see a counselor!), but I never cancelled the appointment, so we went. I was blessed to find out the power of counseling even in that first session: the counselor asked me what I didn’t like about myself when I looked in the mirror, and it gave me the opportunity to say out loud for the first time ever the thoughts that had plagued my mind and monopolized my energy for a very long time. Suddenly, I was no longer alone in my challenge.
My hope is to help you to find the courage to say out loud the things that are holding you back. One of my favorite quotes about human beings is, “What we resist, persists. What we can feel, we can heal.” If you can find that courage to dig deep and be honest with yourself and with me, together we can work to get you feeling lighter, more confident in your ability to cope, and more free from the chains that are holding you back.
A Little Information about Health Care: HMOs vs. PPOs (Part 1 of 3)
Even as a health provider myself, I still wind up having questions about exactly what HMOs and PPOs are, and when you can use your insurance benefits or not. So I thought I'd try to provide a little bit of clarification here.
To begin, I recommend reading this good article about HMOs vs. PPOs. (It has a nice little comparison chart and everything.) "HMO" and "PPO" denote different ways that insurance companies can organize themselves. This is important for you because it helps you to know which health providers (i.e., counselors, doctors, dentists) you can see and how much your insurance company will pay for each of your appointments...and most importantly how much you will be responsible for paying for each of your appointments!
As the article explains, HMOs tend to limit you to seeing only providers who are considered in-network with your plan. If you see someone who is in-network with your plan, then you may pay only a $20, $10, or even $0 co-pay when you have a visit with that provider, and then your insurance company is going to pay the provider the rest. (Keep in mind that if you have a deductible to meet first, then generally you will have to pay the FULL cost of all of your health-related visits until you meet the deductible, and then your benefits will kick in and you'll pay only your co-pay for subsequent visits and your insurance will pay the rest.) The main limiting factor with an HMO is that if you want to see someone who is not an in-network provider with your insurance plan, AKA they are an out-of-network provider, you will generally get $0 of coverage from your insurance company and you will have to pay the full cost of the visit yourself. Thus, with an HMO, if you want to use your insurance, you almost always need to see a provider that your insurance company calls "in-network."
As the article also explains, PPOs tend to offer you two sets of terms, one for in-network providers and one for out-of-network providers. I think this is best explained by using an example. Let's say that you have a session with a counselor and the counselor's rate (price) for the session is $100. Your PPO insurance company will usually have terms like this:
-If the counselor is an in-network provider with your insurance company, then you will pay $20 for the visit and your insurance will send the counselor the other $80. Thus, you pay a total of $20.
-If the counselor is an out-of-network provider (i.e., not in-network), then you will pay $100 to the counselor for the visit. But then you can send your insurance company the superbill/invoice and they will reimburse you $70 for that visit. Thus, in the end, you pay a total of $30.
This example highlights one of the major differences between HMOs and PPOs. A PPO will often (but not always) cover at least some of your expenses even if you see an out-of-network provider, but they usually cover a slightly smaller dollar amount than if you had seen an in-network provider. The HMO will only cover some of your expenses if you see an in-network provider; if you see an out-of-network provider, you're usually completely on your own.
A Little More Information about Health Care: In-Network vs. Out-of-Network (Part 2 of 3)
So what does all of this "in-network" and "out-of-network" provider stuff mean anyway? Let me try to shed some light on this too. Basically, a provider will be considered in-network or out-of-network based upon whether he or she has entered into a contract with your specific insurance company or not. Let's use an example again. Let's say a counselor has set her fees at $135/session. If you want to see this counselor without using insurance (because either you don't have insurance, or you do have it but you don't want your insurance company having to know about all the private stuff that you talk about during your counseling visits, or you do have insurance but this counselor is not in-network with your insurance company and they don't provide you out-of-network benefits but you really want to see this counselor anyway), then the cost will be $135/session. Period. You give the counselor $135 each visit by check, credit card, or whatever other way she accepts payment, and that is that. (This is often referred to as "paying out of pocket" or being a "self-pay client" or "private pay client." I don't know why we make it more complicated by using fancy terminology. It's just finding a service that you want and then paying for it, without the help of insurance or anything else.)
But let's say your counselor has decided to try to contract with Aetna (or Cigna, or Blue Cross Blue Shield, etc.) to become an in-network provider with them. Aetna (or Cigna, or BCBS, etc.) might tell your counselor, "If you want to be an in-network provider with us, we will only pay you $110/session. The client will pay you $30 as a co-pay when they come to your office and then we will send you the remaining $80 later." If the counselor decides that $110 is not enough for the work that she provides, then she will not contract with Aetna and she will not be an in-network provider with them. However if the counselor does decide that $110 is acceptable for the work that she provides, then any client who comes to see her with Aetna insurance will pay her the $30 co-pay in-office, and the counselor will file some paperwork with Aetna after the visit to collect the other $80. (On the insurance company's side of things, before making someone an in-network provider, the insurance company will also verify that the provider has the credentials the company requires for the specific service the insurance company is covering.)
So that's about it. A provider is in-network if they contacted your insurance company, they liked the terms/dollar amount that company offered, the insurance company approved the provider, and then the two parties signed a contract. A provider is out-of-network if they have not done this. Being in-network is often good for counselors because they can attract more clients who have that insurance to work with them. However, some counselors will not contract with a specific insurance company because the company doesn't pay enough (some offer as little as $45/session to the counselor), and other counselors will not take insurance at all because they don't want to be obligated to share the client's private information with the insurance company. Many counselors take this route, actually, because many insurance companies will require that a counselor justify that a client is "sick" enough to see a counselor. This means that the counselor must provide the insurance company a diagnosis code from the DSM-5 in order to justify why the client needs help, may need to tell the insurance company details about the client's life so as to justify why the client can keep seeing them, and may ultimately be told by the insurance company that the client is not sick enough and thus the client cannot see the counselor anymore (at least not with the insurance paying anything). Since most counselors work from a wellness perspective that focuses on your strengths and helps you to grow in your challenges or deficits (instead of from a pathological perspective that focuses on finding something "wrong" with you), many won't even consider insurance. Thus, you need to find out from each specific provider what their terms are, and you need to check with your insurance company about each specific provider to find out how much the company will cover for you or not.
So what does this mean for you and me? At this point in my practice I have opted to not be in-network with any insurance companies. This means I am an out-of-network provider for every insurance plan out there. But it’s not all bad news: if you have a health insurance plan, some insurance companies will pay you back for seeing me as an out-of-network provider, though some will not. I always encourage my potential clients to call their insurance companies and ask about reimbursement before we meet, because I do not want them to have any surprises. I have a document already prepared that I can send to you so that you can have it in front of you when you call your insurance company and it will guide you through what to ask them. Give me a call or send me an email today and I will send you that document...and then hopefully we'll see each other soon in my office or online!
Even A Little More Information about Health Care: HSAs and FSAs (Part 3 of 3)
Similar to how I began part 1 of this series (A Little Information about Health Care: HMOs vs. PPOs, see above), I recommend reading this article to get a succinct and helpful overview of the differences between HSAs and FSAs. This is my summary of that article:
Health Savings Accounts (HSAa) and Flexible Spending Accounts (FSAs) are both special accounts that you can set up to help save you money, because they save you tax dollars. With both of them, you take a portion of your income and put it into the account, and then whatever amount you put in the account never gets taxed (it’s free income!), but then the money in the account can ONLY be used to pay for health-related expenses…you can use these non-taxed dollars to pay for things like annual physicals and counseling appointments, but not for airfare to Aruba. (Drat!)
HSAs seem to be the star players here and are the optimal choice, but you can only open an HSA if you have a high-deductible health insurance plan, meaning a plan that has a deductible of $1,350 or more for an individual, or $2,700 or more for a family. (Apparently not every health insurance plan with a high deductible qualifies for an HSA, so you’d just want to check that whatever particular plan you are thinking of buying does qualify for an HSA if the plan comes with a high deductible, before you actually purchase the plan.) You can put up to about $3,500 into the account per year if you are an individual, or about $7,000 per year if you are a family (the max amounts change a little year to year). So let’s say you make $40,000 of income per year. If you elect to put $2,000 into the HSA, then the $2,000 sits in that account, and you only get taxed as if you made $38,000 that year. The way you use those $2,000 then is that when you have a health-related expense—for instance an appointment with your counselor—you either pay for the appointment with a debit card associated with the HSA and the cost of the appointment is directly deducted from your HSA balance, or you pay with your regular payment options and then submit the receipt to your HSA, the amount of the expense is deducted from your HSA, and then that amount is deposited into one of your regular bank accounts (i.e., you get reimbursed or paid back from your Health Savings Account). HSAs are more desirable than FSAs because they have more flexible terms: you can change how much you want to put into the account at any point during the year, your unused balance rolls over into next year, and your HSA can follow you from employer to employer.
FSAs on the other hand have more limitations such as lower maximum amounts you can put into the account (the max is $2,700 in 2019 compared to $3,500 for HSAs), there is usually only one point in the year when you can choose how much you want to put into the account, often any balance of funds you didn’t use by the end of the year just “disappears” and is not rolled over or paid back to you (!), and in most cases FSAs are connected to your job so they won’t follow you if you change employers. However, FSAs are helpful because you don’t have to have a high-deductible health insurance plan in order to have one! Much like HSAs, FSAs work by you electing to put $X into the account, your income is taxed as though you made Actual Income - $X, and you use the $X money in the FSA for health-related expenses only.
In summary, if you have a qualifying high-deductible health insurance plan, you’re going to have more flexibility with an HSA. But if you don’t have a high-deductible health insurance plan (which is a plus in and of itself already, as high-deductible plans can cause people to have to pay a lot of money out of pocket before their insurance plan actually starts to kick in), then you’re not eligible for an HSA so you should look into getting an FSA. With either account you save money by lowering the amount of income the government considers you made (i.e., you pay taxes on less money than you actually made) and you use the account for health-related expenses. HSAs and FSAs can help you to pay for your counseling appointments at Free Indeed Counseling, as you can submit the amount of money you pay for your appointments to your HSA/FSA and get reimbursed, so long as your HSA/FSA considers psychotherapy appointments to be a qualified medical expense. Practically every HSA/FSA that I have heard of does, but do check with your HSA/FSA before you make your elected contribution amount to the account, so you know whether to include estimated expenses for counseling in your election amount or not.
Quotes and Thoughts about Therapy
Therapy (noun) : something intended to heal or to relieve
"The human soul doesn't want to be advised or fixed or saved. It simply wants to be witnessed."
-Parker J. Palmer
What we resist, persists. What we can feel, we can heal.
If you don't express, you depress.
"Sometimes I remind my clients that sooner or later they will have to relinquish the goal of having a better past."
-Irving Yalom
"We are only as sick as our secrets."
-Phrase often said in AA
"Blessed are those who mourn, because they will be comforted."
-Matthew 5:4
"Between grief and nothing, I will take grief."
-William Faulkner
Self-interest (i.e., taking care of yourself, valuing yourself) is not the same as being selfish.
Meditation, counseling, etc., are not so that you can control your mind; they're so that your mind doesn't control you.
-Paraphrase from Dear Hank and John podcast, episode 141
"The...values of reflection on experience and emotions and intentional action are consistent with humanistic psychology and cognitive behavioral therapy, which are consistent with healthy human development..."
-Linda C. Osterland
"Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself."
-Rumi
"Black and white" is appropriate for clothing and design, but not as an approach to life or a worldview.
"One thorn of experience is worth a whole wilderness of warning."
-James Russell Lowell