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[quote=Anonymous][quote=Anonymous][quote=Anonymous]My insurance has zero out of network coverage for therapists. I've now tried in-network therapists but they just aren't great. I can't find one with more than 5 years of experience and one of the ones I saw actually broke confidentiality (she would tell me all about her other patients and I'm guess would tell them about me). It seems like once a therapist is more seasoned, they stop taking insurance because they don't have to.

I have gotten several recommendations for good therapists but none of them take insurance. I can find someone for less than $200 a session if I take a newer therapist who is being supervised. And you can find therapists for under $100 per session if you are willing to take an intern. But an experienced therapist is at least $200 for a 50 minute session, often more. And based on my experience, I am just not sure it's worth it to see someone who isn't pretty experienced. I have childhood trauma and PTSD, I know my issues are complex and challenging. That's why I want therapy. But I'm not dealing with situational depression for a job loss or a someone who was mentally healthy my whole life and then needs help getting through grief. I have capital "I" Issues.

It just feels like it's only for wealthy people. Spending $800-1000 a month on therapist means I'm basically saving nothing except a retirement contribution -- nothing for my kid's college fund, no other savings or investments beyond my existing 401k contribution. That seems irresponsible. And I don't even know if it will help yet.

Just venting, I guess. I think therapy could help me but the kind of therapy I can afford seems minimally helpful. I guess my current plan is if my parents leave me any money when they pass, maybe I will spend it on therapy to help me process what happened in our family when I was young. I know that sounds morbid. But it seems like that might be the only way I can ever afford to do this (and even then I know I'll feel bad spending that sort of money on my own therapy instead of using it to help my kid or pay down or mortgage). [/quote]

I think it would be worth it for you to find a good therapist, and pay out of pocket for some period of time. E.g., maybe for the first month you see someone once a week, but then you move to 2x/month for a few months, and then maybe once every 3 weeks or once a month for a check in. A good therapist who uses CBT for PTSD can get you started on this and help you help yourself as you move forward. A lot of the CBT work is stuff you practice on your own. I don't think you need to think about therapy as something that goes on forever and prevents you from saving for college or anything else. It can be a short-term investment that can have long-term payoff.

IMO, it's worth a try. I don't think you should think of it as robbing your child of something. In many circumstances, a mom who is more at peace is also a gift to her kids.[/quote]

The problem with this approach, as someone who has tried it, is that good therapy requires a good fit between the therapist and patient, a getting to know you period, and consistency. What happens, realistically, with what you are proposing, is that it takes 2-3 sessions before the patient is even sure if this is a good fit and has established good communication and patterns to actually get to work. Not to say that nothing of value can happen in the first few sessions, it can, but a lot of it is just laying the groundwork for work to come.

So you hit the end of that first month and it feels like you just got started. If you shift to 2x a month at that point, it can disrupt right at the time when you are about to start making progress. There are also practicalities -- 2x a month means neither person is carving out this time on their schedule every week, which can mean the timing moves around a bit. If one or the other is out of town for a vacation or work, you might go 3 weeks between some appointments. So you lose the consistency and with it you can lose some of the rapport and progress.

And that's only if the therapist winds up being a good fit. Sometimes even a great therapist isn't a good fit for reasons that are no ones fault. That means starting over with another therapist. Also in the DC area, there are simply not enough experienced therapists. This means that you often sit on waitlists waiting for an open slot, and when it comes it might be a tough time slot for you. Some therapists also require you to commit to weekly sessions for more than a month to begin, because they are in high enough demand that 2x/month clients underutilize them unless they can pair that client with another so that the time slot stays filled. This requires a longer relationship and the trust that comes from seeing a patient isn't going to cancel or try to move their appointments constantly (which many in DC do, due to intense work schedules).

I think it's worth it to try and find someone on your insurance if paying out of pocket will be a hardship. Even if there's a deductible or you are only getting 50-70% of the appointment paid for, the insurance coverage can ease this process and make it not quite so burdensome on the patient. It can make it feel more worthwhile to find a good fit and to put in the early effort to establish the relationship, because it reduces the pressure to solve problems immediately.

If solving problems immediately is the goal, it can be more cost effective to get your own CBT workbook and maybe take a group class or online class in applying CBT in your life. This may be a more effective way to reap the benefits of a program like CBT right away. But if you are looking for the benefits of talk therapy, it's hard to rush it.[/quote]

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