When I opened my private psychotherapy practice, I made a decision to accept private-pay only. This means I accept payment by cash, check, credit card, or PayPal. More importantly, it means I do not accept or bill insurance. I do not participate in the payment or reimbursement process with insurance companies. This is an important boundary for me as an ethical obligation to my clients and a self-care obligation to myself.
Accepting insurance for psychotherapy is problematic in multiple ways, some of which I explore below.
1. Insurance requires a mental health diagnosis. This does not work for me because I believe diagnoses are flawed, subjective representations of pathological tendencies too easy applied willy-nilly. I recognize the utility and unfortunate importance of categorization & labeling; I also choose to work outside the system when possible. I see my clients as whole, resilient, capable people facing behavioral and emotional roadblocks to fulfillment. I do not see them as diseases needing cures.
2. Diagnoses can easily become a central or integral part of someone’s identity. It is easy to “become” OCD or ADHD once the label is announced, to come to see it as part of one’s core self. I treat people, not diseases, labels or categories.
3. Insurance companies require clinicians reveal diagnoses, symptoms, behaviors, and treatment plans. I’m unwilling to reveal confidential, potentially damaging information if hacked, to the insurance company to justify my clients’ needs for emotional support. Avoiding interactions with insurance companies protects the confidentiality of my clients.
4. Further, insurance companies limit the amount paid for treatment and the number of sessions available to a client. I am not willing to be paid an amount for my professional service that leaves me feeling resentful and devalued. That’s a boundary of mine I must uphold. More pointedly, I’m not willing to have my clients’ treatment cut off or limited by an insurance company. That decision is between my clients and me.
5. A major component of my practice is relationship and couples counseling. Most insurance policies do not cover couples counseling/marriage counseling. Therapists who bill insurance for couples counseling are often doing it under the guise of one client’s diagnosis with the other partner present as support. This does not fit with my ethical standards.
6. Finally, working with insurance companies demands an incredible amount of time and patience to fulfill paperwork demands, pursue reimbursements, re-authorizations for treatment, etc. This is time I could actually be working with clients face to face, which I find invigorating and enjoyable. It is also time I can be taking care of myself so I am at my best when I’m with clients, present and energetic.
Speaking of which, I’m off to catch a break in the weather and enjoy some park time.
If you have questions or comments about this topic, please send me an email or tweet me @FindYourMarbles!
The picture above is my coloring of an image from The Secret Garden coloring book, found at your locally-owned bookstore or online.
In the daunting, isolating world of Entrepreneurs & Start-Up Founders, many people have a hard time getting the emotional support they need. Many of my clients who are Entrepreneurs and Start-up Professionals & Founders report being overwhelmed, without someone to turn to. They feel they can’t turn to their employees to vent, confide, or blow off steam lest they undermine the tenuous morale inherent in an environment with so much uncertainty. They can’t turn to their co-founders, investors or C-levels, lest they undermine the confidence their power-brokers invest in them. They can’t turn to their significant others more than they already do, knowing their work already intrudes on their relationships more than they, and especially their partners, would like.
It is with this dilemma in mind that I provide tailored services to this group. As an entrepreneur myself and a professional with experience supporting Start-Up Professionals making amazing ideas come to life in the vibrant Start-Up community of Denver/Boulder, I am committed to helping provide a safe, confidential space to get emotional support. This helps clients find calm, get centered, gain perspective, and re-focus before it takes a toll on their work and relationships. I bring my Communication, Conflict Resolution and Relationship Counseling skills to help colleagues, co-founders, and C-level professionals create and maintain the positive partnerships they want. Check out this short, interesting article about one partnership benefiting from “couples therapy.”
I am also organizing a confidential support group for Entrepreneurs, Start-Up Professionals and Founders to come together with others in their position, navigating the same turmoil, to create a safe, comfortable community. In this group, members will be able to express, share, listen, process, reflect, challenge, collaborate, and help support each other in growth. Through both of these paths, clients get to build their resilience to burn-out, bolster their stress management, and learn ways to manage distress as it comes up.
One of the most important, impactful strategies we work on is ‘widening the gap between stimulus and response’, as described and practiced in Nonviolent Communication, developed by Marshall Rosenberg: how do we become observers of the world around us and deliberately choose our responses? How can we see an event as it happens and choose our responses to effect the outcome positively?
If these skills and opportunities sound helpful to you, or might be for someone you know, please reach out and spread the word.
What else might be helpful for you to learn to manage the stress and fend off burnout? Let me know @FindYourMarbles
Many of my clients strive to be engaged in their communities by volunteering, serving on Boards of Directors for non-profits, and working as lay leaders. This can be incredibly rewarding and enriching work. Martin Seligman describes this in his PERMA recipe for contentment as Meaning – serving a cause or purpose greater than oneself. It can also be overwhelming and uninspiring at times. Most often I reflect my clients’ desires to persevere and fulfill their commitments to the community.
At other times, it can be appropriate and in the best interest of both parties to part ways. It is important to assess what is the benefit and impact you are having on the organization – what resources and skills do you have to contribute and what is the capacity of the organization to take advantage of all you offer. If you’re an Idea person and the organization needs someone to help fundraise or be a project manager, it may not be a good fit. The same is true if you’re details-oriented and good at wrangling a group to get down to brass tasks but serving an organization that needs a motivator and Big Ideas person.
When an organization does not have the need or capacity to utilize what you offer, it’s easy to become disillusioned with the group, feeling less than competent and useful. Then it’s easy to become a drain on the organization rather than an asset. This is when it becomes helpful to both parties to graciously decline the rest of the commitment and offer to help find a more appropriate person to take your seat at the table. This enables the organization to benefit more directly from someone who has the skill set, interests and resources they need at the moment. It also opens you up to find more tailored, pertinent options for involvement that speak to your interests and utilize your skills and resources in ways that leave you feeling inspired, energized and useful. That kind of partnership is the foundation for strong boards, involved communities, impactful programming in the community. Quitting is not always a negative experience. When done in a measured, deliberate way both parties can benefit.
If you would like to explore how you can consciously decline a draining commitment and learn how you got there and how to avoid it again in the future, reach out and come in to chat. I’m here to help.
Art by Chris Cozen.
Here is a beautifully written short piece on turning inward to see yourself – give yourself the validation, love, compassion you’ve sought externally from your friends and loved ones – written by a beloved teacher of mine, Andra West LeBauer.
“Some thoughts on adjusting to the middle portion of the life span: When we are young we find connection and validation through our peers, and they mirror back to us our beauty and accomplishments. But as we age and life gets busy, people couple, children are born, there is a natural turning into the self and the nuclear family. For most of us there is a longing, or a feeling of loss for the external validation and deep connections we experienced spending deep prolonged amounts of time with our peers. But what we can miss during this energy shift, if we are not careful is this: During this shift there is an invitation that arrives to turn that energy of needing to be seen, validated, loved and appreciated into the self. Seeing ourself, Loving ourself, knowing ourself, finding a gentleness with ourself, and finding validation from the self, and then we get an opportunity everyday to share that deep knowing of ourself with our partners and our children, and if we are lucky, every once in a while we are able to share it with our peers, and it is a beautiful, beautiful thing.”
This speaks to my previous post on being the catalyst for change in a dysfunctional system and turning towards oneself for the external validation or sense of belonging lost in the shift.
You can learn more about Andra here. She is a masterful yoga leader and compassionate teacher in Greensboro, NC.
By no longer colluding in the dysfunction, we up-end the system around us, and the people in it react, often negatively. In the long run though, our actions are the catalyst for positive growth and change. The short-term discomfort is worth the long-term freedom and fulfillment.
When we rescue ourselves by stepping outside the dysfunctional system, others may react negatively because
1) We call attention to their collusion in the unhealthy system,
2) They perceive us as rejecting them (not just the system), and
3) They are forced to take responsibility, or retreat further into denial, for their own ongoing collusion and self-limiting behaviors.
Some people will explode in different ways, at different times. Some will blame or punish. Some will accuse and withdraw. Remember, you’re not rejecting them; you’re rejecting the toxic ways in which you came to relate to them.
You can survive these explosions by preparing for them the same way you prepare for a fireworks show. You know it’s going to be loud, bright and surprising, even scary at times, but it’s very unlikely to physically harm you. You can be prepared to ‘hold tight’ to your new boundaries and at the same time remind yourself the explosion is not any more dangerous than watching fireworks from a healthy distance.
When we create these new boundaries and change our system, we may suffer a loss of external validation and we lose the external containment we had been benefiting from where everyone was helping everyone stay in their ruts, their dissatisfaction, the hyper-busyness, and their boundary-lessness.
Oftentimes this comes with a frenetic energy, positive in the self-congratulatory sense of ‘look at what I’ve done for myself, I’ve started taking care of myself,’ and negative in a ‘now what?’ way. This energy can lead to impulsive behaviors like buying things we don’t actually want, less need, eating too much, not being mindful about interactions (like snippy emails and texts), etc.
When that happens, we can take note of the physical sensations, the buzzing, the whirring, and the swirling in our brains. That’s a sign to find new ways to self-contain, to give ourselves validation, to practice self-care.
Identify the activities that bring you into flow (full engagement, when you lose track of time) and set reminders on your smartphone to do three of them each week. Schedule time. Make it happen. Three each week. This will give you the self-care, validation, sense of worth you need to internalize. Build up the containment and validation only you can truly give yourself in the long run. As much as we deceive ourselves into believing we can get the validation we need from other people or possessions, it never sustains or suffices.
If you want support in making these changes, facing these challenges, call me today and we’ll chat about how I can be helpful: 720-478-0676 or email me firstname.lastname@example.org