Paying for Therapy out of Your Pocket
Paying for Therapy out of Your Pocket
Howard Lambert, Ph. D

If choice, flexibility, confidentiality, and autonomy are important to you, you should consider paying for your own mental health treatment. It may be the most important investment in your future you ever make.

When you pay, your therapist is working for you - not your insurance company

Choice
- Would you like to choose your own counselor? Most people prefer this freedom. When you seek therapy through a managed care company, you are typically given one to three names of counselors in contract. You are not usually given information about the experience level, specialties, or background of the therapists. And there is another problem: If you do not see the therapist to whom the company assigns you, you stand to lose your benefits. If you ask your family doctor, clergyman, or fiend to recommend a therapist, the chances are slim that the counselors you hear about will be on the panel of mental health providers covered by your managed care plan. If you want to choose a counselor based on credentials, reputation, experience, and personality "fit" you likely will have to pay for the treatment yourself.

Flexibility - Most people want their counselors to be totally on their side. Counselors who are paid by managed care companies are in a difficult situation. They work hard to help you achieve relief from your difficulties, but they are under contract with the managed care companies. The companies impose rules and regulations that you may never hear about - rules concerning length of treatment, medications, and how often you can be seen by the counselor (just to name a few). Only when you pay for therapy out of pocket can you and your counselor be totally in charge of length, frequency, cost, and focus on your sessions.

Confidentiality - Have you ever worried that your decision to see a mental health counselor could come back to haunt you? When you use your insurance benefits, perhaps you should worry. There have been an alarming increase in cases in which consumers have been turned down for life or health insurance because they had sought mental health counseling at some point in the past. Managed care and insurance companies have been known to share banks of data with other companies in return for similar favors. Is this illegal? Usually not, because insurers require that you sign a general release of information when you apply for benefits. That puts you in a bind: Sign the release of information and give you the right to privacy, or lose your benefits.

Autonomy - Would you rather not take medications to alleviate your symptoms? Many people prefer not to take psychiatric medications. Some managed care companies encourage their providers to use medication early in treatment for the purpose of shortening the length of therapy. Yet research has shown that this is not an effective strategy. When you buy therapy from an independent provider of mental health services, medications are considered and used only when both you and the counselor decide on this course of action.

Personal Growth - Clients receiving services from a provider who contracts with a managed care plan generally receive ultra-brief "crisis counseling." Some managed care companies even provide a standardized template that instructs the counselor "how to treat" specific problems. Their only goal is to return the client to his or her prior level of functioning (i.e. symptoms reduction). If you wish to achieve a deeper understanding of how your problems developed, to make lasting changes in your life and stop repeating dysfunctional behavior pattern, then you will be better off purchasing psychotherapy from an independent provider. You and your counselor create the goals for your therapy and have total control over the processes used to reach these goals.

Excellent mental health services can help you overcome living problems, resolve relationship struggles, become more productive on your job, and improve your physical and spiritual health. In this era of overly managed care, my advice is that you find the best professional for the job, and then negotiate a fee acceptable to both the client and the counselor. There should be no substitute for quality.