IF YOU ARE CONSIDERING COUNSELING…
Christine G. Glenn, Ph.D. ( 9/07)
If you are considering counseling and are not yet sure whether you want to pursue it or what you really hope for, the following questions may make your decisions clearer and more efficient. Some of the questions will be relevant to you; others will not. Just focus on those that seem important to you. Focus on each question alone before going on to the next one. Your answers may change. You may want to do this more than once.
Why are you interested in counseling?
What do you hope to get out of counseling?
You may also have questions about the usefulness and details of counseling. Some frequently asked questions are discussed below.
Q. Does therapy work?
Over fifty years of research has shown that therapy is helpful for many people.
Some of the factors that influence usefulness are:
Q. How long does therapy take?
Q. Should I use insurance?
This is a complex question. You should consider a number of issues in making this decision.
Using insurance requires a medical diagnosis. That diagnosis becomes part of your permanent medical record. While counselors and doctors have strict ethical codes requiring them to protect your privacy, insurance companies do not. Recent regulatory rules permit insurance companies to share your medical information with other companies or organizations, e.g., other insurance companies, drug companies, federal or state agencies, potentially large companies. They can do this without your knowledge or consent and you cannot prevent this. These regulatory changes are relatively new and we do not yet know how your medical information is and will be shared – but it will be.
Insurance companies require that counseling services be “medically necessary.” The insurance companies define what is medically necessary. The insurance industry has not been clear about the meaning of the term. The definition changes over time and can vary between insurance companies or between policies. Regardless of what is covered now, or what will be covered, the rationale for what is “medically necessary” will be based on a medically formulated diagnosis, despite the generally poor empirical support of the medical model as a way of conceptualizing psychological concerns.
Insurance companies influence counseling decisions. Some insurance companies will require a review of treatment notes and treatment plans and may deny benefits if they disagree with the treatment plans. This is a requirement even though there is no evidence that treatment plans are useful. Insurance companies also put pressure on counselors to use brief or short-term treatment. It is not unusual for counselors who are on an insurance company’s “preferred providers” list to receive reports indicating how many sessions they typically use per client and how they “rate” compared to other counselors. The implied virtue is to provide as few sessions as possible or necessary.
While effectiveness is important, research has shown that therapy works best if decisions, such as the number of sessions, are left completely to the counselor and client. Research has also shown that longer engagement in counseling generally produces better and longer-lasting results. Using insurance is a bit like having someone else in the room with you and your counselor.
If you choose to use insurance, talk with your counselor about the diagnosis that will be used and ask what kinds of information your insurance company requires about you and your concerns.
Paying for counseling out of pocket is a significant financial decision. It is also a question of value; what is valuable to you and how will you allocate your time and money. Talk with prospective counselors about their fees. Some counselors offer discounts if they do not have to bill insurance and complete other paper work. Some counselors offer sliding-scale fees based on your income.
What kind of investment do you want to make in your happiness and well-being?
The decision to work with a counselor remains a highly personal decision. It will depend on your clarity about your goals and your willingness to locate and work with a professional whose training will benefit you. Qualified counselors and psychotherapists are professionals interested in human concerns and in resolving personal questions and problems. They have made significant investments in training and professional development because they know counseling services can be extremely useful.