6 Reasons NOT to Use Your Health Insurance to Pay for Therapy

Have you ever considered paying for therapy out of pocket?

If your health insurance covers the cost of counseling services, probably not. Before I became a therapist, it never crossed my mind to pay any of my healthcare out of pocket—especially if I could take care of everything with a measly $25 co-pay. Now that I’m on the other side of the fence, I actually pay for much more of my healthcare instead of relying on my insurance (and this includes paying out of pocket for my own therapy).

If you’ve read this far, you’re probably wondering, “But I have insurance…why wouldn’t I use it? Why pay more?” I understand the allure of using your health insurance to cover the majority of the session fees, but do you realize what you give up for that co-pay? If not, allow me to shine some light on the truth. I’ve learned a lot of things throughout my career as a therapist. Things consumers don’t know. Things that I would want you to know if I were you. And so I’m here to tell you the things I want all clients to know before/when they are using insurance-approved therapists.

  1. Your therapist has to diagnose you to get you reimbursed.
    Insurance companies require a diagnosis so they can decide if they will pay for therapy or not. This means your therapist must give you a diagnosis that your insurance will cover even if you don’t really need a diagnosis. And these diagnoses follow you. In many cases, mental health diagnoses do not have a statute of limitations meaning they will follow your forever as “pre-existing illnesses.” As a client it is rare that you ever even know your diagnosis, so I would consider this to be one of the most motivating reasons to pay out-of-pocket because when you do, your therapist does is not required to give you a diagnosis.
  2. Your records are not protected.
    Your insurer can audit your records at any time they wish. This means any details that your therapist might not have included in the paperwork (perhaps for good reason) is technically open to the eyes of any “claims specialist” the company hires. Again, this might not matter to you. But if you hold high clearance for a job, or have other reasons you want your information to be held confidential- this is important to know.
  3. Your care is dictated by the insurance company.
    Whenever you are diagnosed, the insurance company will decide how much treatment and what type of treatment you will receive. Meaning, rather than giving you the best care possible that suits your needs, you will be designated a treatment plan based on your insurance company. Simply put, the care of the client is dictated by the insurance company, and the therapist essentially works for the insurance company, not the client. This can compromise the quality of mental health services provided.
  4. Insurance almost never pays the full fee.
    This means you are either going to be responsible for the remainder (which you need to clarify ahead of time) or it means your therapist is working for less than a fair market wage. Most insurance companies reimburse therapists at a very low rate, typically lower than the set fee from the clinician. It makes it hard to do good work with clients when your therapist is worrying about how he or she is going to pay their bills and sustain a practice.
  5. You may end up seeing a generalist therapist, instead of one with the unique skill set you need.
    While many therapists are qualified to treat common challenges such as anxiety’s or depression, if you are interested in working with a specialist to address a specific challenge, you should consider looking out-of-network. Private pay therapists often have niche practices, and if you come across a therapist whose skills speak directly to your needs—perhaps needs you didn’t even know to look for—it’s worth reaching out.
  6. Less investment in the counseling process.
    When people pay for therapy out of pocket, they have more emotional buy in and commitment to therapy. Paying with our own money tends to make us work harder and better appreciate the services we are paying for. Plus, therapy is very affordable. Even at a rate of $100 per hour, you could get 30 hours of therapy (which is far more than the average time needed), for less than getting your kid braces, than two months of an average mortgage payment, about the same as some people pay for one big-screen television, WAY cheaper than a divorce, etc.

So what can you do about it? There are options!

1. If possible, pay cash for sessions. This ensures that your records and diagnoses are entirely confidential documents. The content of your session stays entirely between you and your therapist. And your care is dictated by what you think you need, not your insurer. Many people have a Health Savings Account (HSA) or Flexible Savings Account (FSA) that will help them pay for sessions and operates just like cash- but they don’t realize it.

2. If you cannot afford to do that, consider a non-profit. Many areas have nonprofits that offer low fee counseling based on income or other eligibility. That takes a little digging, but often you can find it on google by looking for “low fee” or “affordable” or “nonprofit” counseling. You will likely see less experienced clinicians, but you will maintain control and confidentiality.

3. See if your insurance company will reimburse you for out-of-network services. This will cost you up front, and your diagnosis will be recorded, but it gives you the freedom to choose any licensed clinician and their records are more protected than if you go with an in-network therapist. Contact your insurance company directly to inquire about the out-of-network reimbursement policy specific to your plan. Your therapist will provide you with a statement/invoice, known as a “Superbill”, that you will be able to submit for reimbursement.


Therapy, especially when you are paying out-of-pocket, is always an additional expense, in more ways than one. There are travel expenses and the time commitment that it takes to make therapy effective. However, the rewards can greatly outweigh temporary monetary costs. How much is too much to pay for peace of mind, the renewal of a relationship, or finally finding freedom in an area of life that has previously seemed unattainable? $500? $1000? $5000? Some people would pay ten times that to experience the real progress and change that can happen in therapy. What is the change you are seeking worth to you?

50 Ways to Practice Self-Love this Valentine’s Day

Think about the last time you were on an airplane. Remember that spiel about oxygen masks? The flight attendant gives a safety demonstration on what to do if the oxygen masks drop. “If there is a drop in cabin pressure, oxygen masks will drop down in front of you. … Be sure to secure yours before you help anyone else.” If you put the mask on your child or neighbor first, you could potentially pass out before you are able to put on your own mask. What if you translated this example into your day-to-day life? What would that look like exactly?

Making your wellbeing a priority is not about being selfish. It is about putting yourself first so that you are better equipped to help others and gracefully handle what the day brings. It is about loving yourself so that you can offer more love to the community around you.

Valentine’s Day gives us an amazing opportunity to focus on loving and honoring ourselves, to give thanks for everything that we’ve done, everything that we are blessed to have, and all that we are able to do. Whether you’re coupled up or flying solo this year, there’s no better time than the month of love to show yourself some TLC. Here are some ideas for treating yourself like the VIP Valentine that you are:

  1. Buy yourself fresh flowers.
  2. Take a long, relaxing bath.
  3. Clean your house or apartment.
  4. Watch your favorite movie. Even if it’s for the 20th time.
  5. Make yourself breakfast in bed.
  6. Repeat the following mantra, “I love and accept myself.”
  7. Have a mini pamper session.
  8. Make a list of fun activities to do and post on your fridge.
  9. Go for a run or a long walk.
  10. Start the day with two minutes of meditation.
  11. Fill your body with food and drink that nourishes it and makes it thrive.
  12. Dress your body lovingly in a gorgeous outfit.
  13. Do something for the first time.
  14. Throw your favorite jammies in the dryer for a few minutes so they’re nice and warm and put them on as soon as you come home from work.
  15. Listen to music. Just close your eyes and listen.
  16. Read a good book.
  17. Buy something you’ve always wanted.
  18. Make a list of all the things you like about yourself.
  19. Set the mood while cooking — candles lit, music on.
  20. Give yourself a manicure.
  21. Plan a fun weekend for yourself and your partner/friends/family.
  22. Write down 10 things you feel grateful for.
  23. Get your sweat on.
  24. Smile.
  25. Write yourself a love letter.
  26. When you grocery shop say, “I am choosing this for my body because I love her.”
  27. Give yourself a massage with beautifully scented lotion.
  28. Do something creative.
  29. Stand up straight and tall.
  30. Try a new, healthy recipe.
  31. Take a nap.
  32. Call your mom and tell her you love her (or your dad, sister, etc.).
  33. Oxygenate by taking three deep breaths.
  34. Put on some music and dance away.
  35. Commit to doing your hair and makeup for a week.
  36. Play video games.
  37. Allow yourself to have that piece of chocolate and savor every minute.
  38. Plan an adventure.
  39. Shut off your email and cellphone for an hour.
  40. Use scented candles or diffuse essential oils.
  41. Complete that project or goal you started.
  42. Play board games with friends or family.
  43. Give yourself a day off.
  44. Self-love mantra: “I am enough. I have enough. I do enough.”
  45. Wear your favorite perfume.
  46. Stretch.
  47. Cuddle with your pet. Or with your human.
  48. Watch a stand-up comedy show.
  49. Host a dinner party.
  50. Hire a coach or a counselor.

Have a wonderful, love-filled Valentine’s Day! Be good to yourself.


5 Tips for Surviving Thanksgiving Post-Election

thanksgiving-post-electionAfter the extremely contentious 2016 election, a peaceful Thanksgiving dinner may prove more difficult than usual. Experts say the particularly divisive election could intensify typical family squabbling this holiday season, especially among relatives on separate sides of the political fence who may be seeing each other for the first time since Donald Trump’s stunning victory on November 9th.

So, how do you get through dinner without it devolving into a shouting match? I’ve compiled a few ideas for you to try. But, remember, if all else fails, there’s always hiding in the bathroom. I am kidding. Kind of…

1. Make the dinner table a no-politics zone.

If you’re hosting an event and want to set early boundaries about what you expect from your guests, inform them ahead of time that when the group sits down to feast, all political talk is off the table. If someone else is hosting the gathering, share this idea them and have them reach out to the guests. Some people, unbelievably enough, are looking forward to talking politics with their relatives. If that’s the case, don’t subject a captive audience to it. When dinner is over, the politically minded can retreat to the den to debate, and everyone else can eat pie and watch football in another room.

2. Find common ground. 

Every American wants security, prosperity and liberty. Our political disagreements stem from different opinions of how to achieve these ends. As much as possible, remind your family of how you are similar before explaining the finer points of how you differ. For example, we all want secure borders. We all want to stop terrorism. We all want to preserve the environment for future generations. Establish these points of agreement at the outset, and you just might discover that those “unreasonable” family members aren’t so unreasonable after all. With this foundation, the same passion that might have become insults and personal attacks will be channeled into meaningful discussion.

3. Be ready to create a conversational diversion.

The best way to keep people from talking about politics is to get them talking about something else. What’s the best thing they’ve watched on TV or Netflix or in theaters this year? Inquire about their vacations, their jobs or their hobbies. Browse the news before dinner and come prepared with some interesting apolitical headlines to discuss. If the conversation starts to turn, be ready with what you’ll say next. Consider responding politely with, “You know, I’m not comfortable talking about that yet,” or, “We know we don’t agree on politics, so let’s not discuss it.”

4. Remember to STOP.

Get ready. This is an acronym that can change your life. When you start to feel annoyed or upset in any way, remember to employ this simple, yet rapid technique that will help take control of the one thing in your power: your response.

Take a breath
Observe the sensations in your body, your thoughts/emotions, your interaction with the other person
Proceed in a way that best supports you, the other person, and your relationship

In moments when we feel flustered, usually our first impulse is to act in a way we’ll come to regret. Austrian physician and concentration camp survivor Viktor Frankl once said: “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” Taking a moment to STOP helps us get into this gap between stimulus and response and claim the power to choose the most beneficial action.

5. Be thankful.

In my family, we go around the table and everyone has to share one thing they are grateful for before we begin eating, and that sets the tone. Remember that Thanksgiving is a time for family. It’s a time to be thankful for those you’re with…and to focus on the things that unite us rather than divide us. No families agree on everything. But at the end of the day, you’re still family. If political conversations get out of hand, affirm to the table that your relationships are deeper than the 2016 election.

Cheers to a peaceful and enjoyable Thanksgiving holiday!

Introvert, Shy, Socially Anxious: What’s the Difference?

introvert-shy-socially-anxious“Introvert”, “shy”, and “socially anxious” are commonly used interchangeably to describe individuals who prefer to keep to themselves or who aren’t very outgoing and sociable. While they may have similar characteristics, the three terms mean different things. Being able to differentiate between them will allow you to develop a deeper understanding of others, helping you build a greater sensitivity towards individuals who do suffer from social anxiety in particular.


The terms introvert and extrovert were popularized by Carl Jung in the early 20th century. Introverts may only seem shy on the exterior because they are typically soft-spoken and reserved. However, not all are shy; introverts find other people and over-stimulating environments to be tiring, and regain energy by resting and being alone. They tend to prefer an evening with a good friend over attending a large party. They are thoughtful, thinking before they speak, and they also prefer to observe rather than participate in discussions.

Compared to shyness, introversion is not a characteristic that is outgrown or developed, but is rather a trait that is inherent in an individual. In contrast, extroverts are people who are energized when surrounded by others, and who enjoy social situations and interacting with others. They prefer to spend time with others than to be alone. At the same time, introversion and extraversion are on opposite ends of a spectrum; there are plenty of individuals who fall in between. Ambiversion is a term that describes people who feel comfortable with social interactions, but who may also talk less and treasure time alone.


People who are introverts often describe themselves (or are described) as shy, but shyness and introversion are not the same thing. Shyness has, at its heart, a fear of negative judgment by others. Think of the difference this way: If asked to a party, an introvert might think about whether they wanted to expend their precious supply of social energy. A shy person, however, might think about how others at the party would perceive them. As author Susan Cain explained in “Quiet,” her landmark book on introverts: “Shyness is the fear of social disapproval or humiliation, while introversion is a preference for environments that are not overstimulating.” One stays home from the party from preference, in other words, and the other from fear.

Unlike introversion, shyness is better understood as a response, rather than a state of being. It’s the social discomfort we feel whenever we worry about measuring up or appearing out of place or awkward. Nearly everyone has felt some degree of shyness at least once. However, severely shy individuals may have further issues with building relationships at school or at work, possibly leading to social anxiety.

Social Anxiety Disorder

Social anxiety disorder, also known as social phobia, does have an element of shyness to it. However, the main difference between the two, is severity.

Severity in the level of anxiety:
Mild anxiety levels in social situations is in keeping with shyness. High anxiety levels in social situations is more in keeping with social anxiety disorder.

Severity in the degree of avoidance:
Little or no avoidance of social situations, is in keeping with shyness. However, avoidance which interferes with life is characteristic of social anxiety disorder. For example, a person suffering from social anxiety may avoid going out, or meeting people, or drop out of school, or avoid careers they are capable of. It interferes with their life now, and in what they want to do in the future.

Severity in the persistence of symptoms:

Generally someone who is shy will feel uncomfortable when meeting someone for the first time. This usually gets better with time, as they become more familiar and comfortable in that social setting. However, someone with social anxiety disorder may continue to be anxious even when they get to know the other person better.

The most distinguishing feature between social anxiety disorder and shyness is that social anxiety disorder debilitates one’s functioning, and not just socially. In adults, social anxiety can impair one’s work functioning and cause conflicts in family life. In children, social anxiety can interfere with academic achievement, school attendance, social hobbies, and making friends. Furthermore, the lack of self-confidence of social anxiety sufferers tends to result in poor assertiveness skills, and often leads to other psychiatric conditions, such as depression, other anxiety disorders, and substance abuse.

Psychotherapy, particularly cognitive behavioral therapy, has been shown to be effective in treating social anxiety disorder. Anti-anxiety medications and antidepressants can also help in some cases. If you are struggling with SAD, reach out for help from your doctor or a licensed mental health professional.

Coping with Today’s Violent World

War and violenceWe are living through terrifying, unsettling times in an unpredictable world. The onslaught of news about violence seems to be never-ending these days, and in consequence, more of us are experiencing increased anxiety, fear and uncertainty as we go about our daily lives. Adults, children, parents, families, professionals, educators, caregivers, first responders, every member of our community—we all need help coping with the difficult emotions and acute responses caused by acts of terror, gun violence and hatred.

Our fears, if persistent, can result in more stress related-illnesses, decreased productivity at work, problems in interpersonal relationships, and poorer quality of life. For some, it can lead to even bigger problems like substance abuse, depression and trauma. So, what can you do to keep your fears in check? Here are a few coping strategies aimed at helping you during these challenging times:

Limit your exposure to the media and social media.

Take your news in small bites. Media outlets need to push the envelope on their stories in order to achieve higher ratings. It’s our job as intelligent, savvy consumers not to get sucked into the hype. Once you have gotten the facts, don’t keep watching replays of events. Seeing disturbing images over and over not only desensitizes one to the event, but also adds trauma upon trauma—further intensifying the reactions to the event. By getting some distance from the news, by turning off the television or social media, we give ourselves a chance to catch our breath and refocus our attention.

Give fear a shape.

Dr. Friedemann Schaub, MD, PhD, author of The Fear and Anxiety Solution explains that fear typically comes from a part of our mind that feels powerless, incapable and small, based on feelings from early on in life. He recommends imagining that fear has the shape and appearance of a child and then speaking to that child as though you are a loving, nurturing parent. “I have found this to be an effective way to interrupt the fear spiral because you’re switching from feeling anxious to being a source of comfort and support,” Schaub explains. It also empowers people to take charge of their emotions and separate their fear from the rest of who they are.

Keep your daily routine.

Maintain a normal routine and lifestyle as much as possible. Unless public safety officials have issued warnings or closed buildings, continue with your day-to-day activities. This encourages us to feel normal by acting normal. Routines provide us a sense of “normalcy”, comfort and stability. Remember that the goal of terrorism is to make you fearful; terrorists thrive on this kind of thing. They want to see the population change their practices. The antidote to this is keeping a routine that enables you to meet people who don’t look like you, people who you wouldn’t otherwise know. Make sure you are getting plenty of sleep, regular meals and exercise.

Reach out.

Reaching out to others—by asking how they’re doing or offering help, for example—counters fear. It helps to help other people, and it can make us feel more connected at times when we’re afraid of other people. Furthermore, people who have strong social support are more likely to successfully cope with fear, anger, sadness, and other difficult emotions related to traumatic events. If you live alone or your social network is limited, reach out to others and make new friends. Connect with other survivors of the event or disaster or participate in memorials, events, and other public rituals. Comfort others or volunteer your time for a cause that’s important to you.

Balance the negative with the positive.

Try to remain mindful of all the positive happenings around you (you may even consider writing out a gratitude list). When we focus too much on human horrors, we lose our sense of safety and security. Remind yourself that these events, while tragic and worthy of our attention and support, do not mean the world is an unsafe place. Think about the honorable people who rescued strangers when their lives were at risk, those who had the good fortune to be saved, and the community that comes together and rebounds. The images and stories of firefighters and other emergency personnel that live on in the hearts of all who watched 9/11 unfold. As Mr. Rogers would say, “Look for the helpers. You will always find people who are helping.” Even in the midst of tragedy, the resiliency of the human spirit shines through.

Get help, if needed.

For some, fear turns into something bigger. If fear is consuming you—if you can’t sleep or focus or function normally anymore or you feel numb or hopeless or are experiencing suicidal thoughts—seek professional help. This is especially important for those who live with depression, substance abuse problems, anxiety or posttraumatic stress disorder (PTSD). Your anxieties can be relieved, but you may not be able to do it on your own. It’s also important to get support from friends and family. They can help keep threats in perspective and be a sounding board for fears and worries.


Prayers and thoughts for a more peaceful world.