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[treehugger1]

I'm seriously thinking about seeing a psychologist (talk therapy) for a very specific issue in my life (marriage). In other words, I'm not depressed, anxious, etc. and yet really need help with this specific issue. I'd very much like to not have to pay $80/hour, or whatever the going rate is for good talk therapy and instead have the sessions covered by my insurance.

However ...

I'm concerned that if I do try to use insurance I will necessarily be diagnosed as having some kind of mental illness/condition, and would very much prefer not to be unnecessarily labelled.

Is this line of thinking correct? Is a specific diagnosis unnecessary? Is there some kind of innocuous catch-all category for people who go for help, say, because they are trying to deal with a bad confluence of events in their lives, a major conflict in a marriage, unexpected death of someone close or some other such one-time stress factor? Should I even attempt to discuss this particular issue with my PCP (whom I will see tomorrow)? Or just spring for the cost myself without even attempting to involve the MDs and insurance co.?

Ideas?

[neutralname]

You are in the USA, right? 

If you pay in cash and don't seek reimbursement, then you don't need a diagnosis. 

If you go through health insurance, the therapist quite likely needs to submit a diagnosis for multiple visits.  They could give you something like 'adjustment disorder' or a mild 'anxiety disorder.' 

It might be that you can get an initial consultation with no diagnosis, and still get it reimbursed. 

Prices will vary a great deal depending on your location and the kind of degrees the person you see. 

I've seen many different kinds of shrinks in my time as one of the worried well, and I'd say you don't need to be worried about stigma unless you plan to run for office or you work in the military. 

The biggest practical problem is finding a good therapist.  I'd spend some time looking up different people and trying to speak with them.  Most therapists, if they are taking new patients, will answer some questions on the phone before you go to see them, and you can get a sense of whether you like them quite quickly.

[voxprincipalis]

They could give you something like 'adjustment disorder'

This.

Insurance works via paperwork, and paperwork depends on numbers and codes, so having a code assigned is kind of inevitable. "Adjustment disorder" is sort-of a catch-all category for "we're figuring out what's going on."

You will also want to look at the in-network vs. out-of-network costs, and see exactly what amount ($ or %) is covered by your university's insurance.

VP

[treehugger1]

The biggest practical problem is finding a good therapist.  I'd spend some time looking up different people and trying to speak with them.  Most therapists, if they are taking new patients, will answer some questions on the phone before you go to see them, and you can get a sense of whether you like them quite quickly.

Would you happen to know if there is a specific kind of therapist, or a specific school that is good at dealing with these one-time, partially pragmatic issues? (As in -- how to deal with a very nice, yet very manipulative person when one has a rather naive, straightforward personality.) I'm assuming this wouldn't be Freudian, for example.

I've read (both good and bad) about CBT. Might someone with this approach be helpful? Are their other schools/techniques?

Of course, when I go to my PCP today, he'll probably just hand me a list of the 5 in-network therapists I have to choose from.

But how does one make sure on the phone or in the first interview not to get a *bad* therapist? Trust your gut? Or are there signs?
 

[macaroon]

But how does one make sure on the phone or in the first interview not to get a *bad* therapist? Trust your gut? Or are there signs?
 

Hi treehugger - I've gone for talk therapy on a few occasions to sort through a very specific issue.  I've gone with the default referral and been a satisfied customer every time.  If you're coming in with a specific, relatively "normal" issue, it's likely that any therapist will do.  You need a great connection with your therapist to get through "I'm at a crisis in my life and I have no idea why!".  You need a therapist with some relevant experience to get through a less-common problem like, "My husband is having a sex change and I'd like to save our marriage"   But you don't have to click too much if you walk in with something like "I want to forgive my spouse but am having trouble moving on."

I didn't need a diagnosis to ~ 8 to 10 visits covered by insurance.  That was honestly all I needed. 

Good luck!

[neutralname]

Treehugger1

Most therapists these days would call themselves "eclectic" with the ability to do particular kinds of therapy.  That's probably what you want: better to avoid someone who holds themselves to be part of some kind of school of therapy, especially psychoanalysts. 

I think the quick answer is that there are no guarantees, and it can take a while before you realize that a particular therapist is not helping.  But if you have a reasonably clear idea of what kind of help you are looking for, you can explain that over the phone and ask whether they have experience in giving that sort of help.  If they are vague or non-committal, then you will probably do better with someone who can give quite specific answers about their experience.

Trusting your gut is good when your gut is a good judge of people.  If you think you are a pretty good judge of character (maybe apart from in choosing spouses!) then it's probably a good guide.  But I think that issue of fit with the therapist is more important if you plan to have many sessions.  If you just want one or two sessions, your main priority is finding someone who can give you good advice.

[bluesocks]

It also depends on your insurance.  We have to pay the full cost until we meet the deductible.  That will take more than 12 visits.  So, you might want to check on that.  

Blue

[treehugger1]

I'm back from the PCP and now see that he has given mean a list of all psychiatrists, even though I specifically asked for a psychologist, briefly explained the problem, and said I wanted "talk therapy." On the referral, it says "talk therapy preferred"

I am personally, philosophically 99% opposed to psychriatric medicine and will not consider taking any psychotropic medication myself, and certainly not for this kind of relatively clear-cut problem.

So, should I even bother calling one of these psychiatrists? Or should I just go back at get a referral to a psychologist?
Hmmm. In the meantime, I'm going to call the benefits line and see if I could just make the switch myself ....

[bookishone]

There are psychiatrists who do talk therapy, but they're harder to find. Ask about it specifically when you're calling around.

[macaroon]

I'm back from the PCP and now see that he has given mean a list of all psychiatrists, even though I specifically asked for a psychologist, briefly explained the problem, and said I wanted "talk therapy." On the referral, it says "talk therapy preferred"

My best talk-therapist was a psychiatrist.  She wouldn't write me a scrip for JACK SQUAT - and I asked for it.   In fact, she encouraged me to be on fewer meds, and got me off of hormonal birth control (which drastically improved my life and my marriage).   I knew she'd be a good talk-therapist from the second visit, though.  

[multinodal]

You might want to call your insurance company or read through your paperwork and see if you actually need a PCP referral to a therapist or counselor (these can be MSWs or PhD psychologists).

In my experience major HMO plans have a separate "mental health" category where you can self refer to a therapist: i.e. you pick one and get them to submit the paperwork if they are in-network, and if they're out of network, you submit the paperwork.

This might be worth looking into as I have found MDs to be woefully uninformed (and uninterested in becoming informed) about basic mental health (as opposed to significant mental disorders and illnesses). In fact, like you, the first time I felt a need for talk therapy, my university-based PCP sent me right to a psychiatrist who thankfully sent me on to a psychologist.

Good luck with your HMO.

[treehugger1]

You might want to call your insurance company or read through your paperwork and see if you actually need a PCP referral to a therapist or counselor (these can be MSWs or PhD psychologists).

< snip >

Good luck with your HMO.

I just did and they gave me a list of psychologists with appropriate specializations (CBT, for example) and an authorization number. It turns out we have no deductible, $25 co-pay, and unlimited visits. Truly, I have a great plan (thanks to sometimes frustrating spouse).

[crowie]

Treehugger, that's great that you have such a good plan.  I just wanted to say please don't be too quick to write off "Freudians" or people who identify as psychoanalysts or psychoanalytic psychotherapists.  It sounds like you are looking for something short term, like a "tune up" to help you sort out some things because you see this as, in your words, a "one-time, partially pragmatic" thing, and you associate the psychoanalytic approach with something longer-term and deeper.  A short term approach may indeed be the right choice for you.  But if the person who you describe as "a very nice, yet very manipulative person" is your husband I am surprised to hear you call it a one-time thing, if you interact with him every day of your life and hope to continue to do so.  In any case, my understanding is that studies show that the best predictor of "success" in psychotherapy is not so much the "style" officially subscribed to by the therapist, but the sense of connection and trust between therapist and client, so let your intuition be your guide.

[treehugger1]

In any case, my understanding is that studies show that the best predictor of "success" in psychotherapy is not so much the "style" officially subscribed to by the therapist, but the sense of connection and trust between therapist and client, so let your intuition be your guide.

So I've heard (and read).

Treehugger, that's great that you have such a good plan.  I just wanted to say please don't be too quick to write off "Freudians" or people who identify as psychoanalysts or psychoanalytic psychotherapists.  It sounds like you are looking for something short term, like a "tune up" to help you sort out some things because you see this as, in your words, a "one-time, partially pragmatic" thing, and you associate the psychoanalytic approach with something longer-term and deeper.  A short term approach may indeed be the right choice for you.  But if the person who you describe as "a very nice, yet very manipulative person" is your husband I am surprised to hear you call it a one-time thing, if you interact with him every day of your life and hope to continue to do so. 

I'm with you here. Personally, I love therapy and wouldn't mind seeing someone once a week, the rest of my life. It's just that my spouse is against it (and in fact attempted to persuade me not to seek therapy of any kind as recently as last night) and presenting the therapy as pragmatic and short-term is a way of making it work for me at  the moment.

Now that I write that I realize how weird and paradoxical it is. The very fact that my partner's beliefs are enough to shape how I even approach therapy shows how pervasive the influence is and how much in fact we might actually need long term therapy.

That said, I'm still going for short term. It could always develop into something longer term, if need be.

[msparticularity]

The very fact that my partner's beliefs are enough to shape how I even approach therapy shows how pervasive the influence is and how much in fact we might actually need long term therapy.

That said, I'm still going for short term. It could always develop into something longer term, if need be.

I have seen in your posts here over the past couple of years that your spouse's behavior when he is "supporting" you tends to look more like "controlling" you to many of us--and perhaps to you? Control issues are certainly nothing new in human behavior, and my own experience and belief has been that there are certainly times when it's worthwhile to stop and figure out whether and to what degree we need to confront a situation, or if we really just want to figure out how to work around it and continue as before. I am guessing that perhaps this is what you might like some support in sorting out.