Good help is hard to find
A recent visit to the therapist's office and some advice on finding help before you need it.
If you know me, you know I think everyone should be in therapy. Or, at least, everyone should have access to it — and try it.
When I first tried to get some form of counseling I was 16 and living with my dad. I’d just moved in with him and was pretty sullen. And why wouldn’t I be? The only life I knew was living with my mom. I felt I barely knew my dad. It also meant moving (again), leaving my friends behind, never becoming the editor of the school newspaper (the new school didn’t have a newspaper), and adapting to new rules and expectations.
Eventually, my dad agree to take me to see a counselor, someone who accepted sliding scale payments. I think it was $40. She talked about herself the whole time. I figured she was just trying to get me to warm up to her, making small talk so I’d be more comfortable.
I wasn’t someone who needed warming up. I had been forbidden to talk about my internal family dynamics my entire life, always afraid my parents would be judged — or arrested then judged — or I’d be taken away and placed with strangers or, worse, my grandparents.
When it was over, I apologized to my dad for wasting the money, told him I didn’t need to go back.
I’m thinking about this now because I’ve been trying to find a new therapist. I changed my health insurance in the middle of last year and haven’t been able to get back to having regular appointments. My last therapist is going through something or is overwhelmed with other appointments, I assume, because she seems to be ghosting me (after saying she wanted to continue working with me).
Most therapists, it seems, don’t take insurance, don’t take my insurance (or yours probably), don’t have any availability, aren’t accepting new patients, or haven’t been practicing for years but haven’t updated their contact information, website, or Psychology Today profiles.
This time around, I’ve called 32 providers who were allegedly taking my insurance and allegedly accepting new patients. Three called me back. One very kind woman tried to refer me to some friends and colleagues who do not accept my insurance and/or are not accepting new patients. Another offered to put me on a waitlist. A third could see me a week later and eventually made an appointment for me.
She couldn’t provide me her office address, though, because she wasn’t sure what it was. No, she couldn’t find out and let me know or text it to me.
“It’s easy,” she said. “I can give you exact directions.”
She could not. I did not want directions, anyway, and, despite her seeming to be nervous about her address being disclosed somewhere, it came up in Google Maps just fine.
Even on the phone, though, I grew impatient with her. I assumed we wouldn’t be a match, but decided to try it out and not make too many assumptions ahead of time.
As soon as I walked in, I knew my gut had been right.
Her office was messy, dirty even, with a couch that looked like it had been trash picked and piles of papers tucked precariously between bookshelves and tables all around me. The books were old and dusty and so were the teddy bears and dolls that lined the walls. The carpet had bits of paper and loose fabric living on it and, when I finally left, a long white hair accompanied me, entangling itself on the red strap of my purse.
I do not judge this woman for being messy or for holding onto too many things. But this wasn’t a home office where her doll collection just happened to overflow into the next room, which happened to be where she saw clients. This was a rented office two stories up. How did she manage to get all this stuff up here? And why bring it in the first place?
It wasn’t an atmosphere of comfort or tranquility. Still, I stayed.
In less than an hour, I learned about her ex-husband, his children, what she did before becoming a therapist and why she prefers California to other parts of the country. She asked me the same questions over and over to the point that I overcame my people pleasing tendencies to ask: “How many times are you going to ask me that?”
She didn’t hear me, so I answered again instead.
She heard me then, but clearly wasn’t listening. I gave her my insurance card — a hint that I was ready for this session to be over — and, as she started to copy my membership ID number (copy machine doesn’t work), she gave me advice.
For her privacy and mine, I’ll leave the advice out and just say that it was … unethical. Category: life altering deception.
I wondered if it was worth reporting to some licensing board. I don’t think so.
Here’s why: I bet she actually does help some people. She told me I didn’t need therapy and she probably couldn’t help me. She may be right. I have chosen to seek therapy because I find it helpful and interesting — and I like to have it in place before I need it. It’s preventative. It’s self-care. It’s dealing with the insurance and paperwork headaches when you’re OK so that, in the event that you are not OK, you don’t have to deal with a bunch of bullshit in order to get help.
The worst time to look for therapy is when you need it most. For some, it can mean life or death. The process of even trying to find mental health services can be so frustrating and crazy making that, instead of getting helped, you’re pushed closer to the edge. Or you just have to accept any help you can get, even if it is pretty bad.
So, I believe this woman may help someone who is in crisis. She may be able to convince someone to keep going when they feel they can’t. During a time when mental health care is so difficult to access, to find and afford, we need all the providers we can get — even the not great ones.
I know. I’m rolling my eyes at myself. It sucks.
Having had good and bad experiences with therapists, I understand why some people would be skeptical of the whole idea. But just because you had a bad piece of fruit one time, do you stop eating fruit?
Even with the best therapist I ever had, it took me six months to see she actually was trying to help me and not hurt me. Looking back, the growth I experienced during that time is astonishing. So is the fact I didn’t quit early on when it was difficult and when I wasn’t sure about her.
To stay with the produce metaphor, she was a fungus.
I didn’t always like mushrooms — they grossed me out. I started to get used to eating mushrooms, realized they were good for me. Still thought they were gross. Then, one day, woah, I love mushrooms. I cannot get enough.
This is how I felt with her, too. I had been resistant. I had given her a hard time. We wrangled our way through it. Then, one day …
Woah.
I could see what I’d been missing in all my moments of solo-self-reflection. I started to face the truths I’d been avoiding. With her help, I started my healing process.
So, yes, I recommend therapy often enough to know I can be annoying about it. Like an evangelist on a street corner sharing the gospel, I get excited talking about therapy.
At work, with friends, to strangers and to you, dear readers: “What? You haven’t tried therapy? You’re missing out! Need help finding someone or figuring out your insurance coverage?”
Here’s my best general guidance:
If you have health insurance:
look at your plan documents or login to your online portal — if you need to see what’s covered download or request a “Summary of Benefits and Coverage.” Scroll or page through this document until you see something (in the left column) like: “If you need mental health, behavioral health, or substance abuse services” … your in-network cost should be listed in that row.
look online through your insurance network’s provider list or request a provider list. Google the providers on the list — see if they’re still alive, still in your area, still active and if they have any good or bad reviews. It may also be helpful to look at any websites or blog posts they’ve written on to see if your values align. (Some therapists, for example, have a religious bend and, if you don’t, you may not want that guiding your therapy.)
call each provider on the list, skipping any filtered out from the above, and leave a message with your first name, phone number and quickly state that you’re looking to see if they’re accepting new patients. Hang up. Call another.
When/if someone calls back, get their name and address, verify they’re accepting new patients and that they accept your insurance. If they seem unsure, tell them you found them on your insurer’s in-network provider list.
Make an appointment AND verify (again) with your insurance that this person is indeed in-network.
Go into the appointment with an open mind.
If you aren’t comfortable or sure whether or not you like this person, ask yourself why. Is it that you would be uncomfortable talking to anyone about these things or is there something in particular about this person that might be a problem for you?
Repeat above steps as necessary and/or if you’re unable to get an appointment with a provider in-network, request a waiver from your health insurance provider. If approved, this will enable you to pay the in-network price for an out-of-network provider. Tip: You will need good reasons as well as patience and fortitude as you try to convince the insurance company to allow you this. It is possible, though, because I’ve done it.
If you don’t have health insurance or behavioral health isn’t covered:
Check if your employer offers something called an “Employee Assistance Program.” It’s a wellness benefit that doesn’t require you to have health insurance through your employer but often gives a certain number of counseling sessions to employees for free. And, yes, your information is still confidential so your bosses won’t know what you discussed while you were there.
Seek out local therapists who provide what’s called “sliding scale” services. The cost will be determined by your income and how much they think you can afford.
Research nearby clinics, hospitals, non-profits and other agencies who may provide free or low-cost services to residents or particular groups you may be a part of (lgbtq+, domestic abuse survivors, women, people of color, at-risk youth, new moms, etc.).
Get help online.
While I cannot personally recommend these services, there are sites like betterhelp.com (starts at $60/week) or TalkSpace.com (starts at $65/week) that offer online counseling. Teladoc looks like it may have some sort of sliding scale option.
There are national, state and local hotlines that provide services to those in crisis, including SAMHSA’s National Helpline, 1-800-662-HELP (4357) or The National Suicide Prevention Lifeline, just dial ‘988'
In this article, Medical News Today lists some other options that may be free for certain groups.
Download an app. These aren’t exactly the same as having sessions with someone, but may be helpful to learn how to check-in with yourself, connect to resources, and/or help with reframing or mindfulness.
I like PTSD Coach, which is free and was created for military veterans but is available to anyone. Disclaimer: This is also the only app in this list I’ve tried and/or liked.
Other free options are COVID Coach, UCLA Mindful, CBT-i Coach (for insomnia), The Healthy Minds Program App, and Insight Timer.
Paid options include Headspace, Calm, Sanvello, Ten Percent Happier, or Bearable. These may have some free content and/or free trials or may be free through your health insurance or employer under something like “wellness benefits” or an Employer Assistance Program.
Before I was in therapy, I read a lot of self-help books. Not all of them are created equal and the genre has some stigma around it, but I have found books really helpful. What I’ve read was really specific to what I was experiencing, so I won’t put those recommendations here. I previously recommended some podcasts for things like anxiety and burn-out.
Finding help can be difficult. So is accepting that you might need some — or admitting you might want some. Starting with something smaller, like a book or a mindfulness app, might help you wrap your head around the idea of talking to someone or even making mental health a priority in your life. Either way, it’s never too late to start something new.
If there’s a topic you’d like me to address in this newsletter, reach out to me or leave a comment. I’ll do my best to find an answer.