Finding a therapist who takes your insurance can be nearly impossible(npr.org)
npr.org
Finding a therapist who takes your insurance can be nearly impossible
https://www.npr.org/sections/shots-health-news/2024/08/24/nx-s1-5028551/insurance-therapy-therapist-mental-health-coverage
194 comments
LPCs, MSWs, LCPCs, LMHCs make up a much larger portion of therapists over PhDs and PsyDs. All take much less schooling.
for anyone else wondering WTF is going on :P
LPC - Licensed Professional Counselor, 24 states + DC
LMHC - Licensed Mental Health Counselor, 7 states (NY)
LCPC - Licensed Clinical Professional Counselor, 7 states (IL)
LPCC - Licensed Professional Clinical Counselor, 6 states (CA)
...
MSW is likely Master of Social Work
( https://www.psychotherapynotes.com/decoding-counselor-alphab... )
LPC - Licensed Professional Counselor, 24 states + DC
LMHC - Licensed Mental Health Counselor, 7 states (NY)
LCPC - Licensed Clinical Professional Counselor, 7 states (IL)
LPCC - Licensed Professional Clinical Counselor, 6 states (CA)
...
MSW is likely Master of Social Work
( https://www.psychotherapynotes.com/decoding-counselor-alphab... )
Where are you getting state counts, and what do they mean here?
As far as I know, most states have procedures for licensing several of these categories, and a couple more besides (Licensed Marriage and Family Therapist, for example).
As far as I know, most states have procedures for licensing several of these categories, and a couple more besides (Licensed Marriage and Family Therapist, for example).
The state counts are from the linked website. (As someone from Europe I have zero idea about any of this. I was just fascinated by the "TLAs".)
Another OAAI member, I see (Overuse of acronyms and initialisms) /s
I know someone who is in training to be a therapist. It still takes an absurdly long time and a lot of money to get any of those degrees. In New York, for example, there's a mandatory multi-thousand-hour internship that essentially treats you as indentured labor for several years -- and this is after getting a masters, which you usually pay for. The average case ends up substantially in debt, for a field where private practice pays mediocre salaries.
(Hot take: the masters was the truly offensive part of the equation -- most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship, even if your salary is low.)
(Hot take: the masters was the truly offensive part of the equation -- most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship, even if your salary is low.)
> most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship
If you're lucky enough to get an unusually good internship.
Won't most of the interns be shadowing someone who is just practicing the same bullshit/pseudo-intellectual woo the elder therapist was taught by the same programs a few years earlier?
If you're lucky enough to get an unusually good internship.
Won't most of the interns be shadowing someone who is just practicing the same bullshit/pseudo-intellectual woo the elder therapist was taught by the same programs a few years earlier?
I don't know, but it seemed to be a pretty different level of thinking from the outside. When you're providing a service, you're grounded by the customer.
Depressed/anxious/whatever people don't generally want to have navel-gazing conversations about gender fluidity and the metaphysical dialectic (or whatever; I'm making up something woo-y). They want to feel better.
Depressed/anxious/whatever people don't generally want to have navel-gazing conversations about gender fluidity and the metaphysical dialectic (or whatever; I'm making up something woo-y). They want to feel better.
Yeah my wife is a MFT and it’s wild how long the process has drawn out before she made money. School, internship, practicum (actually just another internship), license exam, associates licensure requires a supervisor- either you pay them to supervise you or you have to work somewhere that will hire associates.
Anecdotally, as someone who is considering a career change out of tech, I am constantly shocked at just how long and how expensive it is to change careers to do anything else.
I shouldn't be surprised, given how much training it took me to get into this field, but being paid nothing and spending years in training was much easier to tolerate at 20 than at 40.
I shouldn't be surprised, given how much training it took me to get into this field, but being paid nothing and spending years in training was much easier to tolerate at 20 than at 40.
if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue.
No this doesn't work. In Norway there is typically a minimum 6 month wait. Or you can see a private person who takes money today. Same in Germany, and the Netherlands, and basically everywhere else I lived that has subsidized healthcare. It's one of the things that falls through the cracks in my experience.
a) we're rich in the US compared to even Norway b) it's better than what we have, private options will always be there, they just won't be the only options with government competition.
No we are not. The US has a much higher GDP per capita than most of Europe, but not Norway.
But a higher overall GDP (per-capita aside) than even Norway right? We're already spending more than any other country on the planet on healthcare.
Look at the table here: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
The US is spending 50% more per-capita than Norway already and we are worse off. This doesn't include private insurance money which is insane amounts already.
Look at the table here: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
The US is spending 50% more per-capita than Norway already and we are worse off. This doesn't include private insurance money which is insane amounts already.
Yes, but then if you have the kind of systemic issues that need mental health care an extra six months isn't going to break the bank. It's unpleasant and a long time, but it's a pretty far cry from the US nightmare scenario
Yeah or even something like mental health it is impossible to get anything. I also pay for everything mental health related despite having universal health care.
I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid?
The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally.
And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.
The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally.
And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.
The IRS and the USGOV in general is much more lax on preventing citizens from having free money. I get tax return refunds I shouldn't, plenty of people cheat the system and get away with it. For profit insurance companies are harder to cheat. If an insurance company refuses a claim, what are you going to do? go to another insurance company that will do the same thing? If the government refuses a claim, you can vote for the other guy. The government is comprised of "we the people", so it is in the best interest of the people for it to take place of insurance companies, which are certainly not comprised of "we the people".
You should also understand that I am not suggesting that insurance companies should be banned. If you don't like the USGOV subsidy, you or your employer can still subsidize private insurance for you. But now, insurance companies have to compete with the government!
You should also understand that I am not suggesting that insurance companies should be banned. If you don't like the USGOV subsidy, you or your employer can still subsidize private insurance for you. But now, insurance companies have to compete with the government!
I had Medicaid when I was an adult student. Worth pointing out that it was administered by the state of Colorado and not the feds, and was post ACÁ.
It was, by far, the best insurance I have ever had in the US. It was effectively a gold insurance plan with no deductible, a $2 copay, drug and dental coverage.
It was very easy to sign up for, and the paperwork was literally the exact same as buying marketplace insurance.
I found it to be a better experience, and better administered than any other American health insurance I ever had.
If I could have paid money to stay on it when I got a job I would have.
It was, by far, the best insurance I have ever had in the US. It was effectively a gold insurance plan with no deductible, a $2 copay, drug and dental coverage.
It was very easy to sign up for, and the paperwork was literally the exact same as buying marketplace insurance.
I found it to be a better experience, and better administered than any other American health insurance I ever had.
If I could have paid money to stay on it when I got a job I would have.
My brief insurance experience with Medicaid was the best I ever had. It was through State of NY. I happened to break my wrist during that time. It was easy to find a doctor, low/no copays or deductible, and they were comparatively easy to contact.
Every other insurance company I've dealt with has actively cost me money, time and unnecessary pain through ineptitude or beurocracy. My FAANG healthcare was good, but had relatively fewer health issues
Every other insurance company I've dealt with has actively cost me money, time and unnecessary pain through ineptitude or beurocracy. My FAANG healthcare was good, but had relatively fewer health issues
Government support should start a few steps before payment and filing taxes. The solutions that would fix this problem are analogous with having free education instead of student loans
Now we've moved on from talking about direct government subsidy to talking about completely government-operated medicine.
And for that, I'd like you to point me to a state with government-operated medicine that doesn't have a therapist shortage. Because I'm hearing from several people in this thread that their countries have the same problems.
And for that, I'd like you to point me to a state with government-operated medicine that doesn't have a therapist shortage. Because I'm hearing from several people in this thread that their countries have the same problems.
No we haven't- these problems aren't only reducible to a few categories (i.e., free market vs government operated). The shortage of therapists indicates at least an awareness of discontent among many people, and a desire for help (whether just listening, coaching, or deeper interventions). Those relationships used to involve family and friends, but we understand that a therapist is better suited because of better training and less conflict of interest. We don't need trained psychologists for all of those relationships, and much of it could be solved through other relationships that provide comraderie and fraternity- even in a racquet club, finding other people to help you understand the world and support you. That provides an alternative role for government to intervene, instead of the government-operated medicine boogieman. In this case, the government insuring that more people have leisure time to join clubs, go hiking, spend less pressured time with family and friends, would go a long way to improve the problem. That is a different approach from the financialization of cultural life that pervades most government approaches, but it would be much less costly and reap greater rewards
Next time, for comparison, choose a country where half of the political spectrum does not deliberately gimp goverment's ability to do things just to prove government can't do things.
We're commenting on an article from a US news outlet about the situation in the US. I wasn't going to start talking about a random other unrelated country when people are proposing solutions for this one.
Also, I attempted to preempt these comments. They're not clever or new or even particularly accurate:
> And to preempt the comments saying it doesn't have to be this way: it doesn't matter if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are
Also, I attempted to preempt these comments. They're not clever or new or even particularly accurate:
> And to preempt the comments saying it doesn't have to be this way: it doesn't matter if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are
> I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid?
raises hand
I have! I've actually worked a shocking amount with the IRS, not because I'm a criminal but because I'm working class and wasn't educated on how to file taxes more complicated than a 1040-EZ, presumably because it was never expected I would make that much money or own my own business.
Strictly my experience, I would much, much rather deal with the IRS than my insurance company. Yes, they're intimidating at first, but ultimately every person I've worked with both at the IRS and my state agency has been calm, professional, and frankly to a degree I found surprising, extremely understanding about how badly I fucked up my taxes on a number of occasions. I was never treated like a criminal; they explained what I did wrong, how they found out, what I owed, and how to prevent those issues in the future. And I was given interest-free payment plans with a one-time administrative cost to setup, that I now pay monthly. I'll be fully 0'd out in about 2 years.
This contrasts sharply with my experience with my insurance company! My insurance company tries to get out of paying for every last thing they can manage. My dental insurance has a maximum pay out of a measly $5,000 per year, which seems completely backwards to every other insurance I have ever had, but what do I know. You know how fast you can crush 5 grand in dental work? And paradoxically it still has co-pays, so apparently I'm paying so they will cover most of some bills, up to a predetermined maximum. Additionally, since I own my own business, I do have the luxury of choosing my own insurance, which most people can't, and for that luxury I pay simply princely sums each month to insure both myself and my spouse. I've picked the best for my area (at time of comment) and have to spend many many days of unpaid labor every year re-evaluating that choice, both because circumstances and networks change coverages, and because every single year my insurance goes up despite both of us, by and large, being quite healthy, and I get fucking annoyed about it and want to see if I'm getting my money's worth. I wouldn't say I am by a long shot, but the alternatives cover less, and cost more, so I'm still paying.
Frankly, and I don't mean this as a personal attack against you, but I have to assume people who talk like you have never interacted directly with the IRS, and are instead absorbing that opinion through the same cultural osmosis I did, because I too was initially terrified to the bone when I got my first letter from them several years after starting my company, and honestly, they are incredibly over-hyped. The only way to truly get the IRS to take you to to task is to, for years on end, purposely try and weasel out of paying taxes.
I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.
raises hand
I have! I've actually worked a shocking amount with the IRS, not because I'm a criminal but because I'm working class and wasn't educated on how to file taxes more complicated than a 1040-EZ, presumably because it was never expected I would make that much money or own my own business.
Strictly my experience, I would much, much rather deal with the IRS than my insurance company. Yes, they're intimidating at first, but ultimately every person I've worked with both at the IRS and my state agency has been calm, professional, and frankly to a degree I found surprising, extremely understanding about how badly I fucked up my taxes on a number of occasions. I was never treated like a criminal; they explained what I did wrong, how they found out, what I owed, and how to prevent those issues in the future. And I was given interest-free payment plans with a one-time administrative cost to setup, that I now pay monthly. I'll be fully 0'd out in about 2 years.
This contrasts sharply with my experience with my insurance company! My insurance company tries to get out of paying for every last thing they can manage. My dental insurance has a maximum pay out of a measly $5,000 per year, which seems completely backwards to every other insurance I have ever had, but what do I know. You know how fast you can crush 5 grand in dental work? And paradoxically it still has co-pays, so apparently I'm paying so they will cover most of some bills, up to a predetermined maximum. Additionally, since I own my own business, I do have the luxury of choosing my own insurance, which most people can't, and for that luxury I pay simply princely sums each month to insure both myself and my spouse. I've picked the best for my area (at time of comment) and have to spend many many days of unpaid labor every year re-evaluating that choice, both because circumstances and networks change coverages, and because every single year my insurance goes up despite both of us, by and large, being quite healthy, and I get fucking annoyed about it and want to see if I'm getting my money's worth. I wouldn't say I am by a long shot, but the alternatives cover less, and cost more, so I'm still paying.
Frankly, and I don't mean this as a personal attack against you, but I have to assume people who talk like you have never interacted directly with the IRS, and are instead absorbing that opinion through the same cultural osmosis I did, because I too was initially terrified to the bone when I got my first letter from them several years after starting my company, and honestly, they are incredibly over-hyped. The only way to truly get the IRS to take you to to task is to, for years on end, purposely try and weasel out of paying taxes.
I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.
To be clear, I'm not talking about the cultural fear of the IRS, I'm specifically referring to the idea that patterning insurance after the IRS would solve most of the issues that OP brought up:
> - Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.
> - Get your money later instead of now.
> - Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.
This description could be lifted up and dropped in to be describing my tax situation each year. Meanwhile, I've never interacted with the kind of nightmarish insurance companies that some people have, so I'm strictly comparing two relatively painful bureaucracies, not nightmare stories about either one.
> - Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.
> - Get your money later instead of now.
> - Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.
This description could be lifted up and dropped in to be describing my tax situation each year. Meanwhile, I've never interacted with the kind of nightmarish insurance companies that some people have, so I'm strictly comparing two relatively painful bureaucracies, not nightmare stories about either one.
>I'm specifically referring to the idea that patterning insurance after the IRS
Maybe I'm missing something, but I don't see anyone who brought up the IRS as a model example except for you. It seems like people are just talking more generally about steamlined than the current status quo experience, and there are so many ways to steelman that which have nothing to do with analogies to the IRS.
To your credit you did note that you wanted people to take you up on your suggestion of using only bad examples, but I don't think your insistence on that front holds water because this is the type of thing where the difference that makes the difference is going to be the very details you are asking everyone to gloss over.
Maybe I'm missing something, but I don't see anyone who brought up the IRS as a model example except for you. It seems like people are just talking more generally about steamlined than the current status quo experience, and there are so many ways to steelman that which have nothing to do with analogies to the IRS.
To your credit you did note that you wanted people to take you up on your suggestion of using only bad examples, but I don't think your insistence on that front holds water because this is the type of thing where the difference that makes the difference is going to be the very details you are asking everyone to gloss over.
I was responding to GP, who definitely did say they would love to use the IRS as a positive example:
> I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.
I'm not at all sure what you're getting at with the rest of your comment, because it doesn't seem to relate to anything I actually said. I'm insistent that we be realistic about what a US bureaucracy will inevitably look like and not expect it to produce less red tape than is already present. I said nothing about glossing over anything.
> I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.
I'm not at all sure what you're getting at with the rest of your comment, because it doesn't seem to relate to anything I actually said. I'm insistent that we be realistic about what a US bureaucracy will inevitably look like and not expect it to produce less red tape than is already present. I said nothing about glossing over anything.
It's also country specific. HMRC in the UK are pieces of shit I wouldn't scrape off my shoe
I fucked up my taxes one year. I filled out the form letting them know I had made a mistake and paying the amount and that was the end of that.
I messed up an insurance deadline one year. I called in and they sorted it out.
I didn't say the IRS was worse, I just said it wasn't any better.
I didn't say the IRS was worse, I just said it wasn't any better.
Right but I think the point is that it is better at the end of the day. Since we're all sharing our anecdotes, I am familiar with someone who works in a municipality where their entire job revolves around billing and claims for EMS.
The amount of extreme cases of stonewalling, long holds, call transfers, inconsistent interpretations of policy, requests for faxes that get lost, requests for new paperwork, and general lack of urgency, across numerous companies in numerous states, is mind boggling, and easily an order of magnitude more extreme the IRS experiences I've seen shared here.
The amount of extreme cases of stonewalling, long holds, call transfers, inconsistent interpretations of policy, requests for faxes that get lost, requests for new paperwork, and general lack of urgency, across numerous companies in numerous states, is mind boggling, and easily an order of magnitude more extreme the IRS experiences I've seen shared here.
The issue is similar in Germany, where the vast majority has mandatory insurance: Too few therapists for too many people. Even in large cities you might wait months, if they even have waiting lists. It's much easier if you pay by yourself.
Afaik there are many therapists who are qualified and want to take public insurance (reimbursement rates are actually pretty good compared to those for MDs) but in the '90s there was a formula developed for how many therapists are needed per capita, and only that many therapists get licenses to take public insurance. Since the stigma around mental health was much higher then, demand now completely outstrips supply, and the competition for the licenses of retiring therapists is fierce.
Canada: Sure you will never see a doctor, but, when you do it is free!
Canada’s healthcare is managed at the provincial level. So you’re comment is pretty reductive and unrepresentative of many places.
This is my experience in BC as an American immigrant. It doesn’t apply to Toronto or Ontario.
Counselors are very easy to find. I had my pick and the wait was about a week. The province didn’t cover it in my case but my extended benefits did. Most of the ones I talked to offer pay scales based on extended insurance coverage, and many will provide pro bono care. Some counselors are covered by the province if you get a referral from a doctor.
The longest I’ve personally waited to see a general doctor is 6 hours at an ER on a weekend night, typically the wait is about an hour if you go to a clinic in the morning without an appointment.
For specialists, appointments are done on a triage system with a referral. If your case is urgent, or worsening you typically get seen asap. I’ve seen MRIs get done same day, or take as long as six months for non-urgent needs.
What I’ve never seen is someone wait a day with a broken arm to make sure they actually need to see a doctor because they can’t afford it. That’s something I saw twice in college in the states.
I’ve also seen people get referred to a specialist and never get seen because their insurance wouldn’t cover it.
Also seen people declare bankruptcy over medical debts in the states despite having insurance.
Canada’s healthcare system could be improved, but if you have ever dealt with low end insurance or uninsured healthcare in the states, you would understand how much better the system is here.
This is my experience in BC as an American immigrant. It doesn’t apply to Toronto or Ontario.
Counselors are very easy to find. I had my pick and the wait was about a week. The province didn’t cover it in my case but my extended benefits did. Most of the ones I talked to offer pay scales based on extended insurance coverage, and many will provide pro bono care. Some counselors are covered by the province if you get a referral from a doctor.
The longest I’ve personally waited to see a general doctor is 6 hours at an ER on a weekend night, typically the wait is about an hour if you go to a clinic in the morning without an appointment.
For specialists, appointments are done on a triage system with a referral. If your case is urgent, or worsening you typically get seen asap. I’ve seen MRIs get done same day, or take as long as six months for non-urgent needs.
What I’ve never seen is someone wait a day with a broken arm to make sure they actually need to see a doctor because they can’t afford it. That’s something I saw twice in college in the states.
I’ve also seen people get referred to a specialist and never get seen because their insurance wouldn’t cover it.
Also seen people declare bankruptcy over medical debts in the states despite having insurance.
Canada’s healthcare system could be improved, but if you have ever dealt with low end insurance or uninsured healthcare in the states, you would understand how much better the system is here.
Better than never seeing one at all because you can't afford it.
In the UK the NHS waiting list can up to a year.
Same in Norway, which has a directly subsidized phealthcare system for all.
> if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue
Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.
Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.
Medicare is not direct. Direct would be if the therapist worked, on salary, as a therapist, and received a paycheck from the government.
That isn't what "directly subsidized" means, though, that's "directly run". A subsidy is a strictly monetary arrangement, not one where the government actually becomes the employer.
Tricare is perhaps the closest thing we have to direct government healthcare, it handles healthcare for active duty military, it is part of the DoD and contracts out to providers directly (including therapists) and compared to other private insurers they are among the most difficult to work with. My partner is an independent psychotherapist and contracts with various healthcare providers and Tricare has by far the highest rate of spurious rejections, short paychecks, heavy audit requirements, etc and their resolution department is the hardest to work with.
So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.
So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.
It would still be an issue. Even countries with socialized or heavily subsidized healthcare systems tend to have long waiting lists for therapists and strict limits on the number of sessions. Services are rationed everywhere.
in sweden it is almost impossible to find a psycologist. Many years of waiting and that is only if you are an extreme case. If you are just average depressed you can just dream about getting one in your lifetime.
You don't need a PhD to get a license...
But very few non phd therapists practice evidence based medicine
Most therapists I’ve spoken to aren’t PhDs and the one we do work with isn’t noticeably better for outcomes.
>But very few non phd therapists practice evidence based medicine
That's a good point, although people don't seem happy to acknowledge it. In my metro area, the biggest providers of mental health services are aligned with religious organizations or outright promote themselves as offering religious based therapy. It's frustratingly hard to get evidence based treatment free from religious influence.
That's a good point, although people don't seem happy to acknowledge it. In my metro area, the biggest providers of mental health services are aligned with religious organizations or outright promote themselves as offering religious based therapy. It's frustratingly hard to get evidence based treatment free from religious influence.
lol you have that backwards. The LCSWs tend to be evidence based, the PhDs are busy working on their book promulgating their theories.
Lcsw are more like someone you go talk to when you are having a bad day not so much when you need to manage chronic pain, anxiety or ptsd.
Insurance understandably does not want to reimburse much for that.
Insurance understandably does not want to reimburse much for that.
And yet you produced zero evidence. The irony is off the charts.
Okay, here's one thing I really don't get.
There are plenty of native English speakers in third-world countries. Presumably, some of them could become qualified (from a practical point of view, not a legal point of view) therapists. Therapy can be offered via telemedicine, over the internet. At least some of these people are far enough from US jurisdiction that they could probably offer this service to anybody who wants it over the internet, and just not care what foreign governments have to say about it. This feels like an easy way for people there to make relatively large (by their standards) amounts of money. Why isn't this happening yet?
There are plenty of native English speakers in third-world countries. Presumably, some of them could become qualified (from a practical point of view, not a legal point of view) therapists. Therapy can be offered via telemedicine, over the internet. At least some of these people are far enough from US jurisdiction that they could probably offer this service to anybody who wants it over the internet, and just not care what foreign governments have to say about it. This feels like an easy way for people there to make relatively large (by their standards) amounts of money. Why isn't this happening yet?
Sure, if you just want someone to talk to. But most clinical psychologists are dealing with more severe cases. Would you want your suicidal teenager talking to a licensed therapist trained to deal with their case, or to someone overseas whose qualification is that they speak English?
Because people want therapists who’ll connect with them and understand their life experiences.
I’m sure there are fitness/“life” coaches working online from who-knows-where, though. That’s more or less a form of counseling.
I’m sure there are fitness/“life” coaches working online from who-knows-where, though. That’s more or less a form of counseling.
The problem with this, and we see this in the US already with medical providers, is that even if they are 'native' speakers in their own country, they miss a lot of important nuance and conversational skills to work with US native patients. And that's before you even consider the cultural stuff that they just don't have a frame of reference to understand. Someone from a country where women don't have rights, or where normal things like divorce or abortion are illegal, isn't going to be able to offer useful therapy to someone from the US.
I wanted to get short term therapy for a mental health related thing this year, and made the mistake of switching from my PPO to Kaiser thinking that Kaiser would cover therapy sessions since they appeared to have thousands of therapists under their network.
It turns out that Kaiser will only cover you if you have a diagnosed mental condition (eg bi-polar / ADHD). If you don't, then you're completely out of luck. Instead, they refer you to use an app where you can get counseling via text message, and it's only for 90 days.
https://organizations.headspace.com/kp/faq
It turns out that Kaiser will only cover you if you have a diagnosed mental condition (eg bi-polar / ADHD). If you don't, then you're completely out of luck. Instead, they refer you to use an app where you can get counseling via text message, and it's only for 90 days.
https://organizations.headspace.com/kp/faq
I know three people who got therapy from Kaiser without a DSM diagnosis.
It's not easy, but the key is to tell them you require therapy for something. The tricky part is to walk the line somewhere between "I'm really OK" and "I'm approaching suicidal" ... there is a lot in that range and if you're near the former they won't approve it.
What you have to do is ask your PCP for a referral. You'll get a call from a therapist to screen you. You need to convince this person you need therapy.
If you need further help, my email is in my profile.
It's not easy, but the key is to tell them you require therapy for something. The tricky part is to walk the line somewhere between "I'm really OK" and "I'm approaching suicidal" ... there is a lot in that range and if you're near the former they won't approve it.
What you have to do is ask your PCP for a referral. You'll get a call from a therapist to screen you. You need to convince this person you need therapy.
If you need further help, my email is in my profile.
I've unfortunately been through that dance three times already with my Kaiser PCP, Kaiser therapists (via intake survey) and a Kaiser neurologist. There's enough history with my interactions for them to say don't cover.
Sorry to hear that. You can change your PCP anytime, but you can't change the history on their side. I'm not sure how long they keep it, there's probably some law which governs it.
I will say that a family member decided to go outside of Kaiser for therapy because the work to get the official referral was just too onerous. I will mention the website they used: helloalma.com -- I have no affiliation with them. The nice thing about it: you can get a few free consultations with therapists after looking at their profiles, just to vet them. The family member was happy with that process and got someone that helps. Also, they list their "out of network" price and at my urging the family member negotiated the rate to be at the low end of the scale ($110/hr). There are many that list their hour rate in the range of $80-240.
Good luck.
I will say that a family member decided to go outside of Kaiser for therapy because the work to get the official referral was just too onerous. I will mention the website they used: helloalma.com -- I have no affiliation with them. The nice thing about it: you can get a few free consultations with therapists after looking at their profiles, just to vet them. The family member was happy with that process and got someone that helps. Also, they list their "out of network" price and at my urging the family member negotiated the rate to be at the low end of the scale ($110/hr). There are many that list their hour rate in the range of $80-240.
Good luck.
Do you have access to an employee assistance program through work? We have made use of the therapy multiple times and it’s been great. Totally free, 8 sessions per person per incident. You can kick off another set of sessions if there’s another incident you need to discuss. It’s not a long term solution but it’s good to fill in the gaps and get you seen soon.
Update: Trinet does provide this service. Thanks so much for letting me know about it.
I haven't thought about it at all. I'll definitely check it out, thanks!
Also be careful about working to get a diagnosis, because then you risk paying higher life insurance premiums or being denied coverage.
It sounds like there’s a financial incentive for therapists to diagnose patients with conditions they may or may not have…big yikes
> It sounds like there’s a financial incentive for therapists to diagnose patients with conditions they may or may not have…big yikes
I think you might be thinking about this the wrong way. It's not like therapists want to diagnose people with conditions to scam them out of money (which I suspect might be what you're thinking), it's that insurance companies require there to be some specific mental health issue to be willing to cover therapy, so therapists have to come up with some acceptable reason to give to the insurance company.
Insurance companies may accept "adjustment disorder" (which is just basically having trouble adjusting to a life change) for a certain amount of time, but will often want something else eventually, which can just be something like depression or anxiety.
In some sense this means that therapists technically have to "diagnose" something (as in write it down as a possible diagnosis) to bill insurance but usually people are having some sort of issue if they are seeking therapy so it's probably often just a matter of determining what fits.
Arguably maybe it would be better for insurance to cover therapy even without a specific diagnosis, but in any case, having to write down "depression" or something on a form for the insurance company doesn't mean that they're necessarily telling everyone that they have some sort of serious mental condition or need to get on psychotropic drugs (not that therapists who aren't psychiatrists can prescribe those anyway).
Therapists aren't running around diagnosing people who aren't interested in therapy with bipolar or something to get them to hand over their money or to scam insurance companies.
I think you might be thinking about this the wrong way. It's not like therapists want to diagnose people with conditions to scam them out of money (which I suspect might be what you're thinking), it's that insurance companies require there to be some specific mental health issue to be willing to cover therapy, so therapists have to come up with some acceptable reason to give to the insurance company.
Insurance companies may accept "adjustment disorder" (which is just basically having trouble adjusting to a life change) for a certain amount of time, but will often want something else eventually, which can just be something like depression or anxiety.
In some sense this means that therapists technically have to "diagnose" something (as in write it down as a possible diagnosis) to bill insurance but usually people are having some sort of issue if they are seeking therapy so it's probably often just a matter of determining what fits.
Arguably maybe it would be better for insurance to cover therapy even without a specific diagnosis, but in any case, having to write down "depression" or something on a form for the insurance company doesn't mean that they're necessarily telling everyone that they have some sort of serious mental condition or need to get on psychotropic drugs (not that therapists who aren't psychiatrists can prescribe those anyway).
Therapists aren't running around diagnosing people who aren't interested in therapy with bipolar or something to get them to hand over their money or to scam insurance companies.
Psychiatrists / neurologists do the diagnosis. I'm not sure about a financial incentive, or at least in Kaiser's case. It would mean they'd have to cover that person's therapy possibly indefinitely which isn't much of an incentive.
They're more incentivized to not diagnose with a condition.
I was considered not bi-polar and do not have ADHD by a psychiatrist and thus I couldn't get therapy covered.
They're more incentivized to not diagnose with a condition.
I was considered not bi-polar and do not have ADHD by a psychiatrist and thus I couldn't get therapy covered.
There’s an even deeper problem, which is that insurance as a system simply doesn’t make sense for things that are not rare or that affect a sizable fraction of population
If it’s that common, then there’s no need for a large bureaucracy of actuaries, accountants, agents, etc…, in the middle or to serve as your intermediaries.
And a single paperwork error every five years, causing you to spend a few hours sorting it out, would more than outweigh all the tiny advantages that might theoretically benefit the customer.
If it’s that common, then there’s no need for a large bureaucracy of actuaries, accountants, agents, etc…, in the middle or to serve as your intermediaries.
And a single paperwork error every five years, causing you to spend a few hours sorting it out, would more than outweigh all the tiny advantages that might theoretically benefit the customer.
> might theoretically benefit the customer.
As with any for-profit business, benefit to the customer is not a goal in and of itself, but rather an incidental side-effect of obtaining money from the customer, in that it is how the customer is convinced to give up their money.
I would caution against assuming systems such as what you described are intended to help the customer. It sounds like instead, it is intended to help the company, by causing you to have to spend your (not their) time and potentially miss an appointment, saving the insurance company money.
After all, what are you going to do, leave your employer for another one with a different insurance company over an insurance paperwork headache?
As with any for-profit business, benefit to the customer is not a goal in and of itself, but rather an incidental side-effect of obtaining money from the customer, in that it is how the customer is convinced to give up their money.
I would caution against assuming systems such as what you described are intended to help the customer. It sounds like instead, it is intended to help the company, by causing you to have to spend your (not their) time and potentially miss an appointment, saving the insurance company money.
After all, what are you going to do, leave your employer for another one with a different insurance company over an insurance paperwork headache?
This has been my view for a while. Basically health-care != health-insurance.
People I've talked to can't quite to wrap their heads around that idea. Not sure why.
People I've talked to can't quite to wrap their heads around that idea. Not sure why.
Therapists don't diagnose, psychiatists do.
That is incorrect. Some do just depends on qualifications
Isn't that true of all doctors?
Both of the therapists I've seen made it clear up front that they refuse to deal with insurance companies, and expect payment up front. The health insurance industry would make Franz Kafka proud.
That said, I was surprised when I mailed a bunch of bills to my insurer, and requested reimbursement. I figured I was probably wasting my time, but why not see what happens.
Anyway, they mailed me a check. The bills were higher than what my insurance would cover, but my insurance decided to cover a substantial portion.
That said, I was surprised when I mailed a bunch of bills to my insurer, and requested reimbursement. I figured I was probably wasting my time, but why not see what happens.
Anyway, they mailed me a check. The bills were higher than what my insurance would cover, but my insurance decided to cover a substantial portion.
> The health insurance industry would make Franz Kafka proud.
The incentives are Kafka-esque. If you're a provider, your incentive is to maximize billable treatment, and you often have prospective patients who have an extremely limited capacity to evaluate your relative expertise/value bs other options, and they often don't have the time luxury of being able to shop around even if they did (and might be justifiably wary of selecting medical treatment based on discounts anyway).
If you're an insurer, you're selling a product with inherently cross-aligned incentives -- the people with the greatest need for it will not be able to pay enough in premiums to meet your risk pool, the people with the least need for it will have limited incentives to buy in. Good actuarial work can partially balance this out but at some level your incentives have to do with attracting/keeping those with the least need for your product and trying to avoid or ditch people with the greatest. On the other hand, other than patient bankruptcy, insurers are probably the single greatest (if limited) force for cost control in the US system, a fact which doesn't frequently win them any love, and thanks to a certain mix of legally compelled and inherent responsibility found in the industry they do at times come through for people, as your experience may indicate.
Given the incentives, the wonder isn't that there are problems for people and providers who don't want to work with insurance. The wonder is that it works at all, and that there is anyone who continues to focus on market solutions. Hayek was about as big a laissez-faire advocate as you can find in the history of economic thought and even he thought that public insurance had things to recommend it over solely private institutions.
The incentives are Kafka-esque. If you're a provider, your incentive is to maximize billable treatment, and you often have prospective patients who have an extremely limited capacity to evaluate your relative expertise/value bs other options, and they often don't have the time luxury of being able to shop around even if they did (and might be justifiably wary of selecting medical treatment based on discounts anyway).
If you're an insurer, you're selling a product with inherently cross-aligned incentives -- the people with the greatest need for it will not be able to pay enough in premiums to meet your risk pool, the people with the least need for it will have limited incentives to buy in. Good actuarial work can partially balance this out but at some level your incentives have to do with attracting/keeping those with the least need for your product and trying to avoid or ditch people with the greatest. On the other hand, other than patient bankruptcy, insurers are probably the single greatest (if limited) force for cost control in the US system, a fact which doesn't frequently win them any love, and thanks to a certain mix of legally compelled and inherent responsibility found in the industry they do at times come through for people, as your experience may indicate.
Given the incentives, the wonder isn't that there are problems for people and providers who don't want to work with insurance. The wonder is that it works at all, and that there is anyone who continues to focus on market solutions. Hayek was about as big a laissez-faire advocate as you can find in the history of economic thought and even he thought that public insurance had things to recommend it over solely private institutions.
Yep. A lot of people are unwilling to fight their insurance and the insurance providers are depending on this. Same with billing departments in the various healthcare systems, etc.
> I mailed a bunch of bills to my insurer, and requested reimbursement (…) Anyway, they mailed me a check
This is not what I’d describe as “fighting your insurance”.
This is not what I’d describe as “fighting your insurance”.
I've had frustrating experiences with my insurance before, but indeed in this case I just mailed in a form.
There's no reason to be surprised. This coverage benefit was probably clearly stated on your summary plan description. These are short, simple documents that most health insurance plans are legally required to distribute to members.
https://www.dol.gov/general/topic/health-plans/planinformati...
https://www.dol.gov/general/topic/health-plans/planinformati...
Perhaps someone else would not have been surprised in my shoes.
But, rightly or wrongly, reading my health insurance documentation feels to me like staring into the abyss. Indeed, I admit that the expression "clearly stated" provokes exactly the sort of dread I'm describing; it feels like the sort of thing a hospital or insurance company would say while sticking me with a massive unexpected bill.
Whether my reaction is reasonable or not, I can't say, but I do feel deep empathy for the therapists out there who balk at dealing with insurance companies.
But, rightly or wrongly, reading my health insurance documentation feels to me like staring into the abyss. Indeed, I admit that the expression "clearly stated" provokes exactly the sort of dread I'm describing; it feels like the sort of thing a hospital or insurance company would say while sticking me with a massive unexpected bill.
Whether my reaction is reasonable or not, I can't say, but I do feel deep empathy for the therapists out there who balk at dealing with insurance companies.
Thank you for inspiring me to read my health insurance plan’s SPD. I learned some stuff.
The key legal and economic goal of a privately owned health insurance company, is to become entrenched as a legally required intermediary between patients and the “medical cartel.” So functionally the optimal approach for an insurance org is to ensure that they are only required to reimburse for expenses that are mandated by law. Then the trick is to reduce the number of mandatory payments through regulatory capture and obfuscation. See: Medical Biller role at each hospital and lack of consistency transparency etc…
Therapists are not considered part of the medical cartel because they are not required to go to medical school or pass the licensing process for “Doctors.” They can’t increase the service costs unilaterally into longer term revenue. This is why it’s trivial to find a covered psychiatrist - because they legally prescribe medicine which is the best possible outcome for an insurance carrier - their equivalent to SaaS margins.
So therapists aren’t legally “Doctors” and as a result they do not have the legal avenues to create an invoice that a health insurance company would accept as mandatory to pay by law. So there’s only downside to an insurance provider for this.
Therapists are not considered part of the medical cartel because they are not required to go to medical school or pass the licensing process for “Doctors.” They can’t increase the service costs unilaterally into longer term revenue. This is why it’s trivial to find a covered psychiatrist - because they legally prescribe medicine which is the best possible outcome for an insurance carrier - their equivalent to SaaS margins.
So therapists aren’t legally “Doctors” and as a result they do not have the legal avenues to create an invoice that a health insurance company would accept as mandatory to pay by law. So there’s only downside to an insurance provider for this.
That's not really accurate from a legal or health plan perspective. Therapists aren't physicians but they do have somewhat similar (though lower) legally mandated licensing requirements.
https://www.bbs.ca.gov/applicants/
Therapists are considered healthcare practitioners. They have NPI numbers. They can submit claims for professional services to payers using NUCC 1500 forms or X12 837P transactions, just like physicians.
Therapists can choose to join health plan provider networks, just like physicians. On most health plans even out-of-network therapy is covered, but the patient financial responsibility may be higher. Mental health parity with medical benefits is legally required (although some payers aren't fully compliant).
https://www.cms.gov/marketplace/private-health-insurance/men...
There is a legitimate shortage of licensed therapists in many areas because education is expensive and reimbursement rates are low. Most therapists still work in small, independent practices rather than as part of large health systems so dealing with insurance billing is a huge hassle and overhead. Thus many therapists don't join health plan networks and require patients to pay directly.
https://www.bbs.ca.gov/applicants/
Therapists are considered healthcare practitioners. They have NPI numbers. They can submit claims for professional services to payers using NUCC 1500 forms or X12 837P transactions, just like physicians.
Therapists can choose to join health plan provider networks, just like physicians. On most health plans even out-of-network therapy is covered, but the patient financial responsibility may be higher. Mental health parity with medical benefits is legally required (although some payers aren't fully compliant).
https://www.cms.gov/marketplace/private-health-insurance/men...
There is a legitimate shortage of licensed therapists in many areas because education is expensive and reimbursement rates are low. Most therapists still work in small, independent practices rather than as part of large health systems so dealing with insurance billing is a huge hassle and overhead. Thus many therapists don't join health plan networks and require patients to pay directly.
oceanplexian(2)
I often wonder if therapy is "over prescribed" these days.
I've struggled with various problems and therapy has seemingly always made it worse. We would "explore" things which caused me to dwell and dedicate so much brain power to "untangling" ideas. Eventually, I would always be "cured" after some relentless distractions and not the therapy. I truly believe the therapists wanted to help, and our progress felt real... but looking back, it was probably worse than doing noting.
I bring this up because I believe some people need therapy, but many people are encouraged to seek it out for problems that could be overcome with other methods, causing a "therapist shortage." This has downstream effects, like the one posted here.
I've struggled with various problems and therapy has seemingly always made it worse. We would "explore" things which caused me to dwell and dedicate so much brain power to "untangling" ideas. Eventually, I would always be "cured" after some relentless distractions and not the therapy. I truly believe the therapists wanted to help, and our progress felt real... but looking back, it was probably worse than doing noting.
I bring this up because I believe some people need therapy, but many people are encouraged to seek it out for problems that could be overcome with other methods, causing a "therapist shortage." This has downstream effects, like the one posted here.
I suspect that the opposite may be true: That everyone needs talk therapy and this was traditionally provided by pastors, village wise men, extended family co-habitation, etc. Like many things in life, as our society has become more complicated and specialized, clinical social workers have become the specialists who perform that role for many people in society.
I could agree with this. I believe there is a benefit in not having "on-demand" access to a therapist and boundaries with the people you talk with.
>I often wonder if therapy is "over prescribed" these days.
Relevant: "Bad Therapy: Why the Kids Aren't Growing Up" https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/...
Relevant: "Bad Therapy: Why the Kids Aren't Growing Up" https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/...
̶c̶a̶n̶ ̶y̶o̶u̶ ̶p̶l̶e̶a̶s̶e̶ ̶p̶r̶o̶v̶i̶d̶e̶ ̶a̶ ̶t̶l̶;̶d̶r̶?̶ ̶w̶h̶a̶t̶'̶s̶ ̶t̶h̶e̶ ̶m̶a̶i̶n̶ ̶a̶r̶g̶u̶m̶e̶n̶t̶,̶ ̶w̶h̶a̶t̶ ̶d̶a̶t̶a̶ ̶i̶s̶ ̶i̶t̶ ̶b̶a̶s̶e̶d̶ ̶o̶n̶?̶
...
okay, I didn't want to be that lazy, so looked up the author. (Her name is interestingly not on the cover :o)
Abigail Shrier, hm. okay, at least there's a wikipedia page about her. she seems to be a layman when it comes to psychology/psychiatry. and her 2018 book about "Transgender Craze" ... uh, okay.
...
https://thingofthings.substack.com/p/bad-therapy-review-fift...
"""
Much of Shrier’s book is devoted to critiquing Internet Mental Health Culture, [...] I broadly agree with her critiques.
[Her] preferred alternative to Internet Mental Health Culture is what you might call Fifties Dad Mindset.
[...]
Shrier explicitly says that the right response to “minor cutting” is to ignore it.
"""
Amazing book.
...
okay, I didn't want to be that lazy, so looked up the author. (Her name is interestingly not on the cover :o)
Abigail Shrier, hm. okay, at least there's a wikipedia page about her. she seems to be a layman when it comes to psychology/psychiatry. and her 2018 book about "Transgender Craze" ... uh, okay.
...
https://thingofthings.substack.com/p/bad-therapy-review-fift...
"""
Much of Shrier’s book is devoted to critiquing Internet Mental Health Culture, [...] I broadly agree with her critiques.
[Her] preferred alternative to Internet Mental Health Culture is what you might call Fifties Dad Mindset.
[...]
Shrier explicitly says that the right response to “minor cutting” is to ignore it.
"""
Amazing book.
I don't think the problem is that people can't be helped, I think the problem is that most therapists are bad at their job. I would not meet with anyone that has not gotten a PhD equivalent or gone to med school at a reputable place.
I can agree with this.
Just a quick anecdote. One of my problems was public speaking. This was in HS so my parents and teachers encouraged therapy. Unfortunately, this now meant dwelling on my fear of public speaking 3 times a week. We went so "deep" with why I was afraid but tbh it was probably best to keep it as simple as "I'm afraid to mess up"
I was "cured" of this fear by a damn video game. It was coming out the day of my presentation and 90% of my brain was focused on the anticipation of the game, only 10% left to worry about the public speaking. I got up, did the presentation on autopilot and then realized "oh, this isn't the worst thing ever" and never had a problem after. Sure, I get nervous but before I would actually throw up on days I knew I had to speak so... I consider it cured :)
My therapist was a great and qualified person... but I think I would have never made any true progress... just dwell on and dissected my fear into adulthood.
Just a quick anecdote. One of my problems was public speaking. This was in HS so my parents and teachers encouraged therapy. Unfortunately, this now meant dwelling on my fear of public speaking 3 times a week. We went so "deep" with why I was afraid but tbh it was probably best to keep it as simple as "I'm afraid to mess up"
I was "cured" of this fear by a damn video game. It was coming out the day of my presentation and 90% of my brain was focused on the anticipation of the game, only 10% left to worry about the public speaking. I got up, did the presentation on autopilot and then realized "oh, this isn't the worst thing ever" and never had a problem after. Sure, I get nervous but before I would actually throw up on days I knew I had to speak so... I consider it cured :)
My therapist was a great and qualified person... but I think I would have never made any true progress... just dwell on and dissected my fear into adulthood.
For what it's worth, I have a family member who ran a non-profit mental health clinic. According to them, studies have found that advanced degrees have little impact on outcomes. From what I recall, he argued studies showed that the key elements for a successful therapist where following some sort of framework/plan (e.g. cognitive therapy, behavioral therapy, Jungian therapy, etc.) and to be contentious (keep records of each session, come into each session with a plan, etc.).
About me: tenured faculty at APA and APS accredited clinical PhD program. Went to a top clinical program in the US.
Your family member is correct. However, the "framework/plan" in that research is not necessarily a manualized empirically supported therapy, it's having some kind of guiding theory about what's going on and a plan for how to proceed. Much more basic than the EST idea. Research generally doesn't show any replicable differential effect of therapy paradigm, especially after you control for publication bias.
Many of those studies of experience and degree were done long ago though, and I'm kind of interested how more recent studies would hold up.
In general though the most important things are having some working theory and plan about the client, rapport and comfort between the client and therapy, things like that. What makes therapy work is sort of nebulous and hard to pin down.
There are studies, for example, showing that there are better therapists than others, but figuring out what makes someone a good therapist has been much more difficult, and to the extent researchers have done so, it doesn't really track well with the manualized protocol-driven paradigms that have dominated the scientific therapy literature for the last 30 years or so.
It makes me wonder if what someone needs is highly individual-specific, and part of the trick to doing good therapy is figuring that out all around, and successful rapport stems from that.
Your family member is correct. However, the "framework/plan" in that research is not necessarily a manualized empirically supported therapy, it's having some kind of guiding theory about what's going on and a plan for how to proceed. Much more basic than the EST idea. Research generally doesn't show any replicable differential effect of therapy paradigm, especially after you control for publication bias.
Many of those studies of experience and degree were done long ago though, and I'm kind of interested how more recent studies would hold up.
In general though the most important things are having some working theory and plan about the client, rapport and comfort between the client and therapy, things like that. What makes therapy work is sort of nebulous and hard to pin down.
There are studies, for example, showing that there are better therapists than others, but figuring out what makes someone a good therapist has been much more difficult, and to the extent researchers have done so, it doesn't really track well with the manualized protocol-driven paradigms that have dominated the scientific therapy literature for the last 30 years or so.
It makes me wonder if what someone needs is highly individual-specific, and part of the trick to doing good therapy is figuring that out all around, and successful rapport stems from that.
It’s not the degree that matters, it’s just that most people have no way to screen for properly trained practitioners of one of the above plans. A top school will be more likely to have trained the students in these plans correctly by experienced trainers
Absolutely this. Only trust phds from top schools practitioners of evidence based therapies. Unfortunately there is a lot of quality dilution in the field and good practitioners don’t get reimbursed any more than quacks
I’m thinking aloud with you here and not dissuading anybody from taking care of their mental health but wow people really need to learn long term coping techniques. The amount of times I see the word “gaslighting” used to describe everyday interactions has really made the word meaningless in sincerely emotionally abusive situations. Tiktok brain telling everybody that they are screwed together wrong really should be addressed at a policy level.
I've noticed this too. Like you, I hate expressing the idea that therapy is "over prescribed", lest someone with real issues put off not going... but man, people over complicate things.
Knew someone that went to therapy b/c they constantly thought the world would end any second. Why? Because they kept going on reddit/the internet where every top comment is "the world will end soon." They would talk about their "progress" and all sorts of techniques. Their life seemingly revolved around their new problem to the point you didn't want to hang out with them very long because it would come back to their issues. IMO, the "cure" to this problem is talking a long walk in a park or downtown and get the hell off the internet. Out of curiosity, I just checked and they're still posting... latest posts are about monkeypox and how it will kill hundreds of thousands... sad to see.
Knew someone that went to therapy b/c they constantly thought the world would end any second. Why? Because they kept going on reddit/the internet where every top comment is "the world will end soon." They would talk about their "progress" and all sorts of techniques. Their life seemingly revolved around their new problem to the point you didn't want to hang out with them very long because it would come back to their issues. IMO, the "cure" to this problem is talking a long walk in a park or downtown and get the hell off the internet. Out of curiosity, I just checked and they're still posting... latest posts are about monkeypox and how it will kill hundreds of thousands... sad to see.
The world ending would be less treacherous than living each day with the fear of it. Yeah, the cure is just to live in the moment. This is a coping technique. Kids need to be taught this stuff in school.
Yep! It just wasn't healthy at all. I hate the saying "touch grass" but damn if it actually wasn't the fix for this person. As a friend, I wish I could drag them outside and say we're just gonna sit here and people watch.
They visit that r/news subreddit and find the worst articles about conflicts, disease and disaster... its like dude just close the laptop! Frustrates me. You do not need to "identify and label triggering content" you need to get out!
They visit that r/news subreddit and find the worst articles about conflicts, disease and disaster... its like dude just close the laptop! Frustrates me. You do not need to "identify and label triggering content" you need to get out!
Along with gaslighting: projecting, passive-aggressive, and narcissist. All psych words that are being destroyed by people misusing them for their own personal gain (usually adding drama or judging someone they dislike).
Yeah, seeing narcissist everywhere is irritating too. "You did not act in my interest without hesitation, narcissist!!" Coping technique: The world and people in it do not revolve around you, don't create an expectation they will. Also: Assume good intensions.
simple, some people just make a religion out of it. it's a way of life for them. the same way some people obsess over the bible
for some people, it's about finding solutions to specific problems, the scope is well defined, nothing wrong here
for others, it's this monolithic worldview that asserts itself as an authority on problems and solutions
for some people, it's about finding solutions to specific problems, the scope is well defined, nothing wrong here
for others, it's this monolithic worldview that asserts itself as an authority on problems and solutions
[deleted]
Agreed. There's a lot of therapy that used to be addressed via talking an issue out w/ friends/partners/family/church, or other built in cultural institutions. There's a lot of therapy that our in person social networks should be doing (and we should be giving). As we become more lonely and our social institutions fall, it opens the door for the therapization of our modern culture, which seems like a bandaid on a deeper problem. This isn't to admonish therapy, but ideally it should probably be for more severe issues.
I will go even further than that. Talk therapy is the scam of the 2000s.
The trickle that brought what we call therapeutic language into everyday life, the constant references to the narcissism of a partner who, if we are honest, had the great fault of just not wanting us anymore, the masochistic lingering over traumas that are nothing more than everyday life, the safe spaces, the escape from responsibilities that should be ours but we have been taught to assign to society, has had disastrous effects on human relations and also on political discourse.
On top of that, I have rarely, if ever, found people participating in talk therapy getting better. If it were a pill, no honest doctor would prescribe it.
On top of that, I have rarely, if ever, found people participating in talk therapy getting better. If it were a pill, no honest doctor would prescribe it.
Mostly agree with this. In my heart of hearts I truly believe many problems are best left to be abstractions and not "explored." When you explore your problems, you dwell on them and when you dwell on them, you're often not in a good place.
It is all anecdotal of course but like you, I notice that my friends and family that constantly go to therapy never seem to get better... and often times worse. I don't think its a case of correlation either, I think they've just made a mountain out of molehill.
Now, I do want to say there are _many_ people that absolutely need therapy. I think if you just can't function, you need professional help. That shouldn't be discouraged.
It is all anecdotal of course but like you, I notice that my friends and family that constantly go to therapy never seem to get better... and often times worse. I don't think its a case of correlation either, I think they've just made a mountain out of molehill.
Now, I do want to say there are _many_ people that absolutely need therapy. I think if you just can't function, you need professional help. That shouldn't be discouraged.
> my friends and family that constantly go to therapy never seem to get better
Isn’t this true for any medical treatment?
Isn’t this true for any medical treatment?
I would hope not.
I'm still "young" so every visit to a Dr, I've come out with a solution.
In any case, I've gone to therapy and it feels like you're making progress (and perhaps I was) but never fixed the problem.
I'm still "young" so every visit to a Dr, I've come out with a solution.
In any case, I've gone to therapy and it feels like you're making progress (and perhaps I was) but never fixed the problem.
Exactly. If you are cured you stop doing the treatment. If you are not cured but only somewhat better, you continue it.
Cognitive behavioral therapy, the most common type of “talk therapy” these days, shows effectiveness on par with medications in a broad range of studies with good methodology.
It is important to remember that anecdotes are not data.
It is important to remember that anecdotes are not data.
What kind of medications are we talking about, for what "issue" (suicidal thoughts or "my parents are disappointed because I did not go to college and I am feeling worthless") and what is the effectiveness, especially long-term, of either medication or talk therapy?
I certainly present anecdotes, and I also live in this world and I notice and I observe and I evaluate. The comment I am responding to does even less.
The second scam is, of course, couples counseling. I have sporadically watched Showtime's “Couples Therapy,” and I know several people who have gone to a couples therapist. The cost of a 50-minute session with the therapist presented on the show seems to be $700. After watching parts of the program, I can give my prescription to all the couples featured, free of charge: You need to break up and find someone else. It may be a collection of anecdotes, but I have yet to see a couple “fall in love again” or “settle their differences” after expensive couples counseling sessions. It's time to move on.
I certainly present anecdotes, and I also live in this world and I notice and I observe and I evaluate. The comment I am responding to does even less.
The second scam is, of course, couples counseling. I have sporadically watched Showtime's “Couples Therapy,” and I know several people who have gone to a couples therapist. The cost of a 50-minute session with the therapist presented on the show seems to be $700. After watching parts of the program, I can give my prescription to all the couples featured, free of charge: You need to break up and find someone else. It may be a collection of anecdotes, but I have yet to see a couple “fall in love again” or “settle their differences” after expensive couples counseling sessions. It's time to move on.
CBT worked well for me. Unfortunately though after the first few weeks, doing the exercises and thinking about my problems seemed to reel me back into the gravitational pull of my problems right as I felt I was escaping. As you point out, its an anecdote and a sample size of one... but is a factor in my opinion.
Does that demonstrate that therapy is effective or that medications are ineffective?
Not the GP, but I'll comment about ADHD, since that is what I have relevantly read research about.
For ADHD, it appears that therapy < medication < therapy + medication.
When compared head-to-head, therapy is almost as useful as medication, but the issue with therapy is that once the patient stops attending, the benefits tend to diminish rapidly.
However, therapy tends to have less side-effects and less stigma. According to some research, medication efficacy also tends to diminish overtime as well.
For other conditions, I cannot tell you. I feel like it would be too large of a brush to try and paint with. I could see conditions like personality disorders not benefiting from medication as much as therapy. Conditions like schizophrenia might not truly benefit from either. For conditions like depression and anxiety, I think the medications are efficacious if not perhaps less so than therapy, but do not quote me on this one.
For ADHD, it appears that therapy < medication < therapy + medication.
When compared head-to-head, therapy is almost as useful as medication, but the issue with therapy is that once the patient stops attending, the benefits tend to diminish rapidly.
However, therapy tends to have less side-effects and less stigma. According to some research, medication efficacy also tends to diminish overtime as well.
For other conditions, I cannot tell you. I feel like it would be too large of a brush to try and paint with. I could see conditions like personality disorders not benefiting from medication as much as therapy. Conditions like schizophrenia might not truly benefit from either. For conditions like depression and anxiety, I think the medications are efficacious if not perhaps less so than therapy, but do not quote me on this one.
So let’s set aside for just a moment the notion of single payer healthcare as an answer to this. Why hasn’t a point of competitiveness between insurance companies ever been that they keep your workforce healthier, more productive, and easier to retain than the competition?
The biggest cost to an employer is always their roster. The fewer sick days people need, the less burnout causes them to churn, and the healthier and happier people are overall, the lower the training, recruiting, and redundant staffing cost.
It feels natural to me that in an employer paid healthcare system like the one we have in the us, the employer should demand the highest quality coverage possible by that metric as long as it reduces staffing overheads.
The biggest cost to an employer is always their roster. The fewer sick days people need, the less burnout causes them to churn, and the healthier and happier people are overall, the lower the training, recruiting, and redundant staffing cost.
It feels natural to me that in an employer paid healthcare system like the one we have in the us, the employer should demand the highest quality coverage possible by that metric as long as it reduces staffing overheads.
By far the number one thing any employer I've worked for has done to reduce my number of sick days and visits to the doctor/pharmacy was remote work. Offices and gathering large numbers of people from over a wide area into a confined space by its nature is a vector for spreading infections. This is before even getting into issues like what a stressful commute does to the body and how it limits one's time that could, though not necessarily will, be used for healthier activities. But just the elimination of picking up colds, flus, and other infections from the office has had a significant impact on the number of sick days I've used. There also have been times when I was sick but not too sick to be productive. In the past I would have had to consider if using up a sick day and having no productivity was a good trade-off for not going into the office and possibly infecting others.
> competitiveness between insurance companies
Maybe we should question this assumption that insurance companies intend to compete. It strikes me as very difficult to compare insurance companies. Some of them don’t even keep up to date information about the doctors that are in network (you have to call the doctor to ask).
Maybe we should question this assumption that insurance companies intend to compete. It strikes me as very difficult to compare insurance companies. Some of them don’t even keep up to date information about the doctors that are in network (you have to call the doctor to ask).
Payers (insurance companies) do compete aggressively, but they mainly compete on issues relevant to benefits administrators who make the decisions at large employers about which health plans to offer to employees. Those administrators need to hold down costs for self-insured employers, and having larger provider networks means higher costs.
My guess is that despite the strong long term overall link, it's too difficult to draw a meaingful link between any particular executive decision on this and any particular outcome, causing a tragedy of the commons. I think it's a good guess because it's a powerful explanation for many other such questions about "Why don't they just ____?"
Patients on Medicare/Medicaid plans have similar or worse issues finding therapists who take that insurance, so I am mystified as to why anyone would think that a single-payer system would be any sort of solution.
While in principle I think you're probably correct that providing good mental health services to employees makes for a more productive workforce, it's tough to connect cause and effect in a mathematically rigorous way. We just don't have high-quality studies in this area to establish cost effectiveness. And many employees tend to leave anyway for other reasons.
We really ought to break the link between employment and health coverage. That part never made any sense.
While in principle I think you're probably correct that providing good mental health services to employees makes for a more productive workforce, it's tough to connect cause and effect in a mathematically rigorous way. We just don't have high-quality studies in this area to establish cost effectiveness. And many employees tend to leave anyway for other reasons.
We really ought to break the link between employment and health coverage. That part never made any sense.
People switch insurance fairly frequently, so if you could pay to improve someone's health, the insurance company is not all that likely to see much benefit.
Most employees at my current firm stay 2-3 years. That means that if you could "fix" a medical issue, it would often need to pay for itself in a year or two, which is unlikely.
Unfortunately, the economics to seem to favor what the insurance companies are often accused of doing: finding excuses to deny treatment.
Edit: Typo
Most employees at my current firm stay 2-3 years. That means that if you could "fix" a medical issue, it would often need to pay for itself in a year or two, which is unlikely.
Unfortunately, the economics to seem to favor what the insurance companies are often accused of doing: finding excuses to deny treatment.
Edit: Typo
Increasing employee pay would also boost morale, but it would be detrimental to retention - move money in their pocket means people have more options to quit outright or find a different job.
The same applies to good healthcare - employers WANT their employees to be utterly dependant on them and just barely scraping by so they're stuck.
Crappy coverage is a feature, not a bug.
The same applies to good healthcare - employers WANT their employees to be utterly dependant on them and just barely scraping by so they're stuck.
Crappy coverage is a feature, not a bug.
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My employer offers therapy solutions like Lyra, so somebody agrees with you. No reason for BCBS to be involved.
Because those are long-term effects, and most companies have literally zero decision makers with any incentive to care about the long term. They all know the game. They're there to parasitize as much value as possible from the company or its common-stock holders in the short term and then fail upward and repeat the cycle. The long-term health of the company is completely irrelevant to everyone who matters.
Cherry on the cake is - People start looking for therapists when they're struggling the most.
Navigating the Kafka-esque mess is hard enough when you're well. But if you're clinically depressed and struggling to get out of bed, booking an appointment can feel like an unsurmountable wall.
Navigating the Kafka-esque mess is hard enough when you're well. But if you're clinically depressed and struggling to get out of bed, booking an appointment can feel like an unsurmountable wall.
Not only that, but even if there were zero barriers with insurance, finding a therapist is still hard.
Because finding good people that you click with is hard, whether that’s hiring employees, finding a romantic partner, or finding a therapist.
The online therapy companies that provide an “instant match” haven’t really solved this, any more than a temp agency has solved hiring top talent.
Because finding good people that you click with is hard, whether that’s hiring employees, finding a romantic partner, or finding a therapist.
The online therapy companies that provide an “instant match” haven’t really solved this, any more than a temp agency has solved hiring top talent.
Yes, that is difficult. But someone who might be suffering from a severe mental health condition probably shouldn't start with looking for a therapist. Instead it would usually be better to make an appointment with their primary care provider and see if a referral to a psychiatrist is medically necessary.
For lesser issues, many employers now offer Employee Assistance Programs (EAP) as part of their benefits package. This can be a relatively quicker path to get a few sessions with a therapist or counselor.
For lesser issues, many employers now offer Employee Assistance Programs (EAP) as part of their benefits package. This can be a relatively quicker path to get a few sessions with a therapist or counselor.
> Several insurers told ProPublica that they are committed to ensuring access to mental health providers, emphasizing that their plans are in compliance with state and federal laws. Insurers also said they have practices in place to make sure reimbursement rates reflect market value and to support and retain providers, for which they continually recruit.
Journalists could use an LLM to fetch the obligatory predictable responses from corporate spokespeople, to insulate the journalists' souls from that.
Journalists could use an LLM to fetch the obligatory predictable responses from corporate spokespeople, to insulate the journalists' souls from that.
The point is to give them a chance to respond. Then they can't come back later and say "why didn't you talk to us?"
It's often not that helpful, but it's standard journalistic practice to give them a chance.
It's often not that helpful, but it's standard journalistic practice to give them a chance.
Well then, lets go the other way. It would be nice if standard journalistic practice evolved to evaluating what business drones said rather than just repeating it verbatim. "When asked for comment, <company> responded but said nothing useful"
Healthcare (in the US) is insanely expensive for physical health, often with insurance being “difficult”. Hence not sure why anyone would be surprised that mental health is similar.
I got new insurance this year through my state's insurance marketplace. They said my existing therapist was in-network. This was news to her. I called and spoke to them. They insisted. She called and spoke to them. They insisted.
So they've been paying her $150 a week for me instead this year. She doesn't know how she ended up being considered in their network as she practices solo, but here we are.
The system is vastly more convoluted than I think anybody on any side actually realizes it is.
So they've been paying her $150 a week for me instead this year. She doesn't know how she ended up being considered in their network as she practices solo, but here we are.
The system is vastly more convoluted than I think anybody on any side actually realizes it is.
> The system is vastly more convoluted than I think anybody on any side actually realizes it is.
This is intentional. It's a game of attrition, and the insurance companies hold all of the cards.
This is intentional. It's a game of attrition, and the insurance companies hold all of the cards.
I'll be honest, I've been really pleasantly surprised with mine. They cover mental health visits without a limit. They cover consultation with a dietitian without limit. They cover physical therapy at 60 sessions, no other questions asked.
They even have a number you can call when your doctor is recommending you have a procedure to find out where you can have it done at the lowest cost. It's staffed by "nurse navigators" whose job is to dig through their data and find what the average cost has been with in-network providers for other people with your plan and find out which one saves you (and the company) the most money. If you decide to go with one of their recommendations of your doctor's original one, they'll call both providers and arrange to have the relevant documents and approvals moved for you, and then they'll send you a gift card because you saved them money too!
It hasn't been flawless by any means, but it has really seemed like they're on my side and helping me through all this confusing stuff.
And I'm on a marketplace plan with cost-sharing reduction because I'm making sure my income ends up being just high enough not to be on Medicaid, but to get full subsidy plus CSR, so I'm paying <$50 a month for it with $0 deductible and <$2k OOP max.
I've decided they're what I wish all health insurance companies were like.
They even have a number you can call when your doctor is recommending you have a procedure to find out where you can have it done at the lowest cost. It's staffed by "nurse navigators" whose job is to dig through their data and find what the average cost has been with in-network providers for other people with your plan and find out which one saves you (and the company) the most money. If you decide to go with one of their recommendations of your doctor's original one, they'll call both providers and arrange to have the relevant documents and approvals moved for you, and then they'll send you a gift card because you saved them money too!
It hasn't been flawless by any means, but it has really seemed like they're on my side and helping me through all this confusing stuff.
And I'm on a marketplace plan with cost-sharing reduction because I'm making sure my income ends up being just high enough not to be on Medicaid, but to get full subsidy plus CSR, so I'm paying <$50 a month for it with $0 deductible and <$2k OOP max.
I've decided they're what I wish all health insurance companies were like.
In every other respect, I have excellent insurance. But the shit they put my therapist through seriously makes me wonder why she even bothers. Every story in that article echoes her own experience with insurance.
Lawyers: where's the class action lawsuit on behalf of therapists alleging a pattern of denial of payment?
Don’t think it would help people get therapy.
The big companies already have a pile of cash they’ve allocated for when they get sued, as the cost of doing business.
So maybe a class action suit happens, and insurance companies have to pay $1 billion in damages. Lawyers get their cut, a bunch of therapists get a $1k check, and zero patients get more therapy.
The big companies already have a pile of cash they’ve allocated for when they get sued, as the cost of doing business.
So maybe a class action suit happens, and insurance companies have to pay $1 billion in damages. Lawyers get their cut, a bunch of therapists get a $1k check, and zero patients get more therapy.
There must be a pain point beyond which insurance companies are willing to actually provide the services they promise. Perhaps jail time for execs might move the needle?
(Genuine Q) why do so many Americans [appear need to] have a therapist compared with - sorry, not sure how to put this - the rest of the planet?
It doesn’t feel like a genuine question you followed it up with a snide jab.
Assuming you didn’t: as a non American who emigrated to the US, the answer is fairly clear. My home country (UK) pretends like if you need therapy you either mentally weak (time to man up!) or on the verge of an inpatient psychiatric hold. Marriage counceling is just a desperate prelude to divorce from people that can’t see the writing on the wall. I would never _ever_ tell anyone on the UK if I was taking psychiatric meds.
America doesn’t have the same stigma, at least in the coastal states. So people get help. People talk about getting help.
Modern life stress is not limited to the US. It’s just the US that talks about it the most. Mental illness is not limited to the US either, they’re just more willing to use medications. And it saves lives. Had I been in the UK with mental illness I have (just the very commmon depression/anxiety power combo) I might be dead by now.
I also take great exception to the idea that there has been some seismic change in life that has resulted in more mental health crises. They were just manifested via more normalized alcoholism and home abuse instead.
Assuming you didn’t: as a non American who emigrated to the US, the answer is fairly clear. My home country (UK) pretends like if you need therapy you either mentally weak (time to man up!) or on the verge of an inpatient psychiatric hold. Marriage counceling is just a desperate prelude to divorce from people that can’t see the writing on the wall. I would never _ever_ tell anyone on the UK if I was taking psychiatric meds.
America doesn’t have the same stigma, at least in the coastal states. So people get help. People talk about getting help.
Modern life stress is not limited to the US. It’s just the US that talks about it the most. Mental illness is not limited to the US either, they’re just more willing to use medications. And it saves lives. Had I been in the UK with mental illness I have (just the very commmon depression/anxiety power combo) I might be dead by now.
I also take great exception to the idea that there has been some seismic change in life that has resulted in more mental health crises. They were just manifested via more normalized alcoholism and home abuse instead.
I suspect there's a number of factors:
If you are comparing to the population of the world as a whole, then I suspect that's because many people in poorer regions simply don't have access to therapy.
If you are comparing to wealthy industrialized nations (e.g. Western Europe and Scandinavia) then I suspect that America's lack of work life balance, lack of social safety net, repressive moral culture, high gun violence, etc. play a role.
I suspect that in some cultures people like pastors and family members play some of the role of therapists to a greater degree than in America.
If you are comparing to the population of the world as a whole, then I suspect that's because many people in poorer regions simply don't have access to therapy.
If you are comparing to wealthy industrialized nations (e.g. Western Europe and Scandinavia) then I suspect that America's lack of work life balance, lack of social safety net, repressive moral culture, high gun violence, etc. play a role.
I suspect that in some cultures people like pastors and family members play some of the role of therapists to a greater degree than in America.
> I suspect that America's lack of work life balance, lack of social safety net, repressive moral culture, high gun violence
Are Americans in therapy directly affected by those issues, or - how can I put this - merely worried about those issues in general terms?
The Economist wrote recently about how political views appear to affect mental health in the USA. The title feels unnecessarily inflammatory, for which I apologise, the article's content feels much more balanced.
https://www.economist.com/united-states/2024/04/04/are-ameri... ( https://archive.is/iWAaP )
Are Americans in therapy directly affected by those issues, or - how can I put this - merely worried about those issues in general terms?
The Economist wrote recently about how political views appear to affect mental health in the USA. The title feels unnecessarily inflammatory, for which I apologise, the article's content feels much more balanced.
https://www.economist.com/united-states/2024/04/04/are-ameri... ( https://archive.is/iWAaP )
What do you mean by "directly affected?" The lack of a social safety net makes me worry about myself (and loved ones) and what might happen in the event of severe job loss or health misfortune. In my city I see people living on the streets almost every day - it is a recurring reminder of the thin line.
Almost by definition, anyone who is directly suffering from the lack of a safety net -- because they are falling through where it would be, and living on the street -- is unable to gain access to therapy, because they wouldn't have money to pay for it.
Almost by definition, anyone who is directly suffering from the lack of a safety net -- because they are falling through where it would be, and living on the street -- is unable to gain access to therapy, because they wouldn't have money to pay for it.
From OP's linked article:
>It is possible that liberalism does not just correlate with sadness but may exacerbate it. Musa al-Gharbi, a sociologist at Stony Brook University, has noted that educated, affluent white liberals have come to endorse the idea that America is systemically racist, leading them to view other racial and ethnic groups more warmly than their own. “This tension—being part of a group that one hates—creates strong dissociative pressures on many white liberals,” he wrote in the journal American Affairs. Another hypothesis, advanced by Jonathan Haidt, a social psychologist, and Greg Lukianoff, a lawyer, is that liberals are performing a reverse cognitive behavioural therapy on themselves: promoting not resilience and optimism about incrementally improving the world but catastrophic rumination about problems such as climate change and fearfulness of disagreement even on university campuses. Such habits of mind can deepen depression.
>It is possible that liberalism does not just correlate with sadness but may exacerbate it. Musa al-Gharbi, a sociologist at Stony Brook University, has noted that educated, affluent white liberals have come to endorse the idea that America is systemically racist, leading them to view other racial and ethnic groups more warmly than their own. “This tension—being part of a group that one hates—creates strong dissociative pressures on many white liberals,” he wrote in the journal American Affairs. Another hypothesis, advanced by Jonathan Haidt, a social psychologist, and Greg Lukianoff, a lawyer, is that liberals are performing a reverse cognitive behavioural therapy on themselves: promoting not resilience and optimism about incrementally improving the world but catastrophic rumination about problems such as climate change and fearfulness of disagreement even on university campuses. Such habits of mind can deepen depression.
> leading them to view other racial and ethnic groups more warmly than their own
I smell Great Replacement Theory bullshit. Even liberal white people still like white people. Even "diverse" shows have white people. Even comparatively less-racist places STILL have an advantage for white people.
This just isn't real. Sorry, it's made up.
I smell Great Replacement Theory bullshit. Even liberal white people still like white people. Even "diverse" shows have white people. Even comparatively less-racist places STILL have an advantage for white people.
This just isn't real. Sorry, it's made up.
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Personally, one of the biggest factors that impacts my quality of life is not my own financial problems but my friends' problems. E.g. having enough money to eat out isn't much good if no one else can go with you. It's hard to have fun when your friends are worried about making ends meet. Etc.
So even if it doesn't happen to them, it may directly effect them.
So even if it doesn't happen to them, it may directly effect them.
This comment strikes me as unintentionally helpful in understanding the problem.
"Gun violence" is of course factually a non-issue in America. Being scared of guns is like being scared of shark attacks or being struck by lightning- technically possible, but realistically such a small risk for the average person that it rounds to 0. But, if you follow certain news or get your social media algorithms tuned to show you certain content, it can seem like this big scary thing.
I also can't really fathom what "repressive moral culture" someone is imagining in America today. There has never been a time of greater tolerance for diverse sexual expression, recreational drug use, religious freedoms or alternative lifestyles. In 2024 you can be a tattooed queer polyamorist pagan who goes to Burning Man for a week and then returns to your corporate finance job on Monday.
But, all the "content for you" algorithms everywhere on the internet will have huge swaths of people afraid of their neighbor and society at large and believing they're under attack and marginalized.
"Gun violence" is of course factually a non-issue in America. Being scared of guns is like being scared of shark attacks or being struck by lightning- technically possible, but realistically such a small risk for the average person that it rounds to 0. But, if you follow certain news or get your social media algorithms tuned to show you certain content, it can seem like this big scary thing.
I also can't really fathom what "repressive moral culture" someone is imagining in America today. There has never been a time of greater tolerance for diverse sexual expression, recreational drug use, religious freedoms or alternative lifestyles. In 2024 you can be a tattooed queer polyamorist pagan who goes to Burning Man for a week and then returns to your corporate finance job on Monday.
But, all the "content for you" algorithms everywhere on the internet will have huge swaths of people afraid of their neighbor and society at large and believing they're under attack and marginalized.
I think this may depend on where in the US you live. In the South, a real consideration in interactions is "what if this person decides to shoot me" likewise behaving in a way that is perceived as immoral (read: queer) is a great way to lose your job or (if you are a minor) be thrown out of your home.
Since guns are the leading causes of death for children in the US, I don't think gun violence is correctly considered a non-issue. Comparing it to lightning is laughable.
Around 80 deaths per year, including adults and children, by lightning strikes. Versus 120 deaths by guns PER DAY, including adults and children.
https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7250-H.pdf https://wonder.cdc.gov/mcd.html
Additionally, when most of ones accessible news sources are full to the brim with polarizing topics, this leaves with limited options. I'd venture a guess that most people would like to hear what is going on in the world around them, even if the news is as negative as it is.
Around 80 deaths per year, including adults and children, by lightning strikes. Versus 120 deaths by guns PER DAY, including adults and children.
https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7250-H.pdf https://wonder.cdc.gov/mcd.html
Additionally, when most of ones accessible news sources are full to the brim with polarizing topics, this leaves with limited options. I'd venture a guess that most people would like to hear what is going on in the world around them, even if the news is as negative as it is.
It's not a question of need, it's a question of want, and available resources to support those wants. The US is sufficiently productive that it can allocate people to relatively less important tasks. If a country barely produces enough to eat, then there's no room for therapists. No knock on therapists - this is basically true of everything. The more productive we are, the more "extra stuff" we can afford to have/do.
Roughly speaking, I'd conjecture that it is because America has always been an idealistic country.
As the Declaration of Independence says, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." This is not a uniquely American sentiment, indeed the phrase was largely borrowed from the writings of John Locke, an Englishman -- but it does feel very American to me. (Moreover, the fact that about half the signers of the Declaration were slaveholders puts an odd twist on it, which also feels quite American.)
If some aspects of your life are going well, and not others? It feels American to me to believe that you can have it all, that if you're experiencing problems then you should not grin and bear it, but rather that you can and should solve them.
This is my personal conjecture, and of course is highly debatable.
As the Declaration of Independence says, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." This is not a uniquely American sentiment, indeed the phrase was largely borrowed from the writings of John Locke, an Englishman -- but it does feel very American to me. (Moreover, the fact that about half the signers of the Declaration were slaveholders puts an odd twist on it, which also feels quite American.)
If some aspects of your life are going well, and not others? It feels American to me to believe that you can have it all, that if you're experiencing problems then you should not grin and bear it, but rather that you can and should solve them.
This is my personal conjecture, and of course is highly debatable.
This is a significant factor in overmedicalization in America I think. Therapy catches a lot of it since it is both broad in scope and difficult to objectify. It is a shame that so much money is wasted to provide worse outcomes in some cases: eg overprescription or overuse of inpatient stays.
If I had to guess, more money in selling people meds that they don't really need, profits get funneled into advertising and media outreach, positive feedback loops, social contagion sets in, etc
Therapists don't typically prescribe medication, but they have a role in the pipeline of prescribing it
Therapists don't typically prescribe medication, but they have a role in the pipeline of prescribing it
Because, I think, literally everyone would benefit from therapy. It's mostly a stigma and money thing why people don't.
Americans have been breaking down the stigma and some have money, so they get therapy. In other countries this may not be the case.
Americans have been breaking down the stigma and some have money, so they get therapy. In other countries this may not be the case.
>It is no measure of health to be well adjusted to a profoundly sick society. J. Krishnamurti
I'm not trying to jab or anything, but I think this is highly due to social media. Some people genuinely have issues and difficult mental problems, this isn't aimed at them, and they do need professional help.
But there is a whole cottage movement of people advising people to go see a therapist to deal with all sorts of (controversially and arguably) benign stuff. Everything from bad breakups, to "toxic traits" they need to address, to family issues, to "issues" they got told is the cause of their dating woes, etc. I haven't been able to put a finger on it definitively, but it's present and is definitely influencing people.
If I were to put my "right wing" hat on, I'd respond and say it's because of all those damn lefties urging people to "talk about their feelings and stuff". That might be a tad too dismissive, but there is something to it behind the pointed accusation; and we all know how heavily pervasive social-media is at driving the behavior of the American populace, aided by the heavily-left-leaning tech companies which actively don't allow the natural immune reaction society has to large-scale gaslighting.
For all we know, people are being gaslight on a large scale, and therapy is trying to put a bandage of it because all these affected people can't reconcile the real world with the craziness of "The Narrative". Some people maybe just need someone to talk to too, you know? Maybe there is more of that in America because they're all forced to self-censor and repress themselves.
</rant> This turned out to be a rant and I let my bias show.
Edit. Now that I think about it, there is arguably even more censorship in the EU so maybe that's not it. Perhaps it's more blatant and people all know it's "forbidden" speech, rather than being forced or gaslight into thinking their thoughts are wrong.
But there is a whole cottage movement of people advising people to go see a therapist to deal with all sorts of (controversially and arguably) benign stuff. Everything from bad breakups, to "toxic traits" they need to address, to family issues, to "issues" they got told is the cause of their dating woes, etc. I haven't been able to put a finger on it definitively, but it's present and is definitely influencing people.
If I were to put my "right wing" hat on, I'd respond and say it's because of all those damn lefties urging people to "talk about their feelings and stuff". That might be a tad too dismissive, but there is something to it behind the pointed accusation; and we all know how heavily pervasive social-media is at driving the behavior of the American populace, aided by the heavily-left-leaning tech companies which actively don't allow the natural immune reaction society has to large-scale gaslighting.
For all we know, people are being gaslight on a large scale, and therapy is trying to put a bandage of it because all these affected people can't reconcile the real world with the craziness of "The Narrative". Some people maybe just need someone to talk to too, you know? Maybe there is more of that in America because they're all forced to self-censor and repress themselves.
</rant> This turned out to be a rant and I let my bias show.
Edit. Now that I think about it, there is arguably even more censorship in the EU so maybe that's not it. Perhaps it's more blatant and people all know it's "forbidden" speech, rather than being forced or gaslight into thinking their thoughts are wrong.
Also hard to just find a therapist, let alone one you like. The simple fact is that there's plenty of demand and zero supply. This is why you see so many 'personal' and 'life' coaches now btw. It's an absolute cluster.
This is absolutely true, all of it. The insurance companies do not have the incentive to do what is best for the patient. I've been shocked at how little they were willing to cover, with very little justification, even when extreme depression and suicide was a possibility. Just think, they are willing to spent north of $1 million on a patient for complex cancer surgery, but are unwilling to spend 20k to pay for therapy that is proven to prevent a suicide.
Cancer when left untreated costs the insurance a lot of money, even if only for palliative care. Suicide on the other hand is a one-time event with minimal, if any, insurance cost. It's a trivial business decision.
Someone who has killed themselves is no longer paying you a monthly premium.
In the US, the insurance is probably through (and mostly paid for by) the employer. As long as the employer hires a replacement, they're back to where they were.
As depressing as it is, I bet there's a table out there that covers this (and the risk that the replacement is poached from some other company that pays the same insurance company).
As depressing as it is, I bet there's a table out there that covers this (and the risk that the replacement is poached from some other company that pays the same insurance company).
This is not to be taken as mental health advice (merely an anecdote), but yesterday I was thinking about needing therapy to deal with my issues and I had the thought to use ChatGPT. Wow, it was absolutely incredible in providing me with what I needed.
I think therapy with a professional would be really useful if you have no idea what your problem is, but I think if you're able to put your problem into words then LLMs can be useful.
I think therapy with a professional would be really useful if you have no idea what your problem is, but I think if you're able to put your problem into words then LLMs can be useful.
I might have to give this a try one day. In my experience, therapy as a tool to improve one's life is overrated and not worth the money. But hey, that has been my experience over a long period of time with many different providers. Everyone is different.
This is very true. My Wife has seen a therapist for dealing with her dad’s death and her mom’s new boyfriend situation as well as mom’s irrational behavior. Luckily I have been saving in an HSA for nearly ten years. Paying for it is no big deal. My company also had free sessions as part of our company provided employee assistance program.
Our current and our previous major insurance companies both have covered therapists listed along side other types of doctors on their website.
Made it super easy for us to find one. My wife saw one literally in walking distance from our house.
Made it super easy for us to find one. My wife saw one literally in walking distance from our house.
Your house is probably not going to burn down, but if it does the financial impact would ruinous. So we pay a little bit each month to insure against this rare outcome.
Some of health insurance looks like this, but many parts of it don’t.
Some of health insurance looks like this, but many parts of it don’t.
Finding an insurer that pays therapists a rate in line with their level of education and specialization can be nearly impossible, and time spent filling out the billing paperwork (often only to be rejected for payment or even "clawed back" after the fact) isn't billable.
Many folks I know that have private clinical practices address the tension between this and ensuring that there's access for people that can't afford the full rate out of pocket by charging a really high rate for most patients and then doing sliding scale/pro bono work.
Many folks I know that have private clinical practices address the tension between this and ensuring that there's access for people that can't afford the full rate out of pocket by charging a really high rate for most patients and then doing sliding scale/pro bono work.
Keep in mind that most therapists only get to keep 50-60% of the paid rate. So if insurance covers 200$ an hour, they take home 100-120. Which seems decent until you realize they only have 5-6 or so billable hours a day and the rest is paperwork and insurance bs. Also a typical Ph.D had an additional 10 or so years of post secondary education income/opportunity loss.
there is rula: https://www.rula.com
you put in your insurance and location, and they find you a provider.
also, some therapists don't take insurance (or recommend you don't use it) because supposedly if you do, then part of that agreement is that they tell the insurance company your treatment plan, which includes the diagnosis, that may be available to your employer. doctor/patient confidentiality seems like there are some exceptions here.
you put in your insurance and location, and they find you a provider.
also, some therapists don't take insurance (or recommend you don't use it) because supposedly if you do, then part of that agreement is that they tell the insurance company your treatment plan, which includes the diagnosis, that may be available to your employer. doctor/patient confidentiality seems like there are some exceptions here.
Piggybacking on this to share my BIL's company https://www.meetnirvana.com/. It helps therapists look up patients' insurance details quickly and easily.
Not just a shameless plug, either: I really believe in their mission, and did a short stint with them.
Not just a shameless plug, either: I really believe in their mission, and did a short stint with them.
What does the business side of therapy look like ? How do they measure success ? I’ve seen patient surveys , but stated conditions are biased.
Therapy doesn’t seem like healthcare . People enter the system and receive care without recovery
It just seems like legitimized drug dealing. Just make the psychotropics over the counter and save the world hundreds of billions
Therapy doesn’t seem like healthcare . People enter the system and receive care without recovery
It just seems like legitimized drug dealing. Just make the psychotropics over the counter and save the world hundreds of billions
Therapists generally can't prescribe drugs. Usually only physicians (or PAs/NPs supervised by physicians) can prescribe psychoactive medications, especially the scheduled ones. A few states do grant limited prescribing authority to licensed psychologists (not therapists).
In practice they refer a clinician who writes a prescription based on their report and a 15 minute screening. It’s theatre
Psychotherapy is easy to acquire overseas with online meeting software with a fraction of the cost.
The entire American Medical Industrial Complex is designed to extract as much money from customers as possible.
Fun fact, therapy is usually not covered by Medicare at all( and when it is you can literally have a year wait). So you have a system in which working class person just have to get through it, and anyone with means will be told they have dozens of things wrong with them.
Better Help sells user information. The venture capitalist tech bros have a new market.
When I was at my lowest, broke , without any health insurance at all, I had a friend who listened to me complain about my latest eviction for hours at a time. That did more for me that any therapist ( who almost always watch the clock to cut you off ).
I plan to pay for her children to go to college. I make a tech bro salary and it's not a lot of money to me.
The Quest For Community and Tribe are great books on what's wrong with modern society. In my grandma's time the average person attended church ( I'm am atheist, but I value the community aspects), at least one social club, and she was a member of a union.
How many community connections does the average person have today ?
Fun fact, therapy is usually not covered by Medicare at all( and when it is you can literally have a year wait). So you have a system in which working class person just have to get through it, and anyone with means will be told they have dozens of things wrong with them.
Better Help sells user information. The venture capitalist tech bros have a new market.
When I was at my lowest, broke , without any health insurance at all, I had a friend who listened to me complain about my latest eviction for hours at a time. That did more for me that any therapist ( who almost always watch the clock to cut you off ).
I plan to pay for her children to go to college. I make a tech bro salary and it's not a lot of money to me.
The Quest For Community and Tribe are great books on what's wrong with modern society. In my grandma's time the average person attended church ( I'm am atheist, but I value the community aspects), at least one social club, and she was a member of a union.
How many community connections does the average person have today ?
>“The way to look at mental health care from an insurance perspective is: I don’t want to attract those people. I am never going to make money on them,”
Exactly why healthcare should be a human right and not a business. As someone who’s grown more conservative over the years, this is where I draw the line. Unfortunately since people will always see mental health as secondary to physical, this will always be overlooked.
Exactly why healthcare should be a human right and not a business. As someone who’s grown more conservative over the years, this is where I draw the line. Unfortunately since people will always see mental health as secondary to physical, this will always be overlooked.
> As someone who’s grown more conservative over the years, this is where I draw the line
At the thing that personally affects you. Just like all conservatives: all problems are fake problems until they're real for you. Disgusting.
At the thing that personally affects you. Just like all conservatives: all problems are fake problems until they're real for you. Disgusting.
Never claimed it personally affected me. You can think it does because that’s convenient and fits your narrative but we both know you don’t know.
Comments like these are lazy, destructive and downright judgmental. They only further explain why we can’t get along, take care friend.
Comments like these are lazy, destructive and downright judgmental. They only further explain why we can’t get along, take care friend.
- Get paid half as much
- Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.
- Get your money later instead of now.
- Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.
- Have to lose patients when their coverage runs out
Meanwhile, there's overwhelming demand for therapists in many cities and plenty of people who will pay cash. I truly believe that many therapists are not in it for the money... but if they are going to make less money, let's at least figure out a way to handle the bureaucracy so that their jobs are more enjoyable.