Archive for the ‘Uncategorized’ Category

You, Your Insurance And Privacy of Our Work Together

Wednesday, October 13th, 2010

“Do you take insurance?” Yeah. I’m in-network (“par,” in insurance terms – participating) with several plans and take assignment. I’m not in-network (“non-par” – I don’t par…never mind. You get the idea) with many more than I’m in with. There’s various reasons for that, none of which really matter here. Feel free to email me if you really need to know but, trust me, that’ not what this is about.

Personally, I’d rather you not use your insurance. That way we can keep things just between us (the two of us, not the two of us and a lot of other people.) I know that you want to have your insurance company pay me (“par”) for part of your treatment or reimburse you (“non-par”) for some of what you paid me. It makes absolute cents. Dollars and cents. Unless you work for the exceedingly rare, and growing rarer all the time, companies that pay your entire premium, you pay a lot for your share of the premium on your health insurance. You want to get something for that hard earned cash that’s not going into your paycheck. Even if your policy doesn’t cover “behavioral health,” you may have a flex or cafeteria plan that you can use to cover some of the period of treatment, some sessions, something.

I get it. I feel the same way about my health insurance. I want to get something back for the money that’s paid in. It’s why we have insurance, right, so that we don’t have to pay the whole ginormous cost of examinations, treatments, medications, devices, etc., etc? Yeah, that’s all real swell but there’s a good reason, maybe several, why you should consider not using your insurance for your psychotherapy/psychoanalysis/mental health treatment. Can you guess what it is?

Money? No. That’s not it. Yeah, sure, I can ask for more money from you if you pay out-of pocket than the fees that the insurance companies “negotiated” in the contract for “par” situations. Even if I can charge you more if I’m non-par because I don’t have to accept the rate the insurance company wants to pay, it’s still not about the money.Please believe me on this.

OK, I’ll give you a hint: look at the title again. The part that says “…Privacy of Our Work Together.” That’s my big concern and needs consideration on your part before you simply say “I pay for the insurance and I want to use it where ever I can.”

Have you stopped to think about how I get paid or you get reimbursed? Of course you have. I do something that goes to the insurance company and they send me a check (or deposit to my account) or I give you something, you combine that with something else, send it to the insurance company and they send you money. Simple. As easy as 3.1416.

Not so fast, Kimosabee. What’s on that claim form that goes to them? The CPT code (that tells them what procedure was performed, e.g., 90806= O(ut)P(atient) psychotherapy, 45-50″ (minutes,) no med(ication) eval(uation.) That tells them how much they pay out for what went on in the room. We can all agree that this is pretty harmless and doesn’t really do much in the way of leaving an artifact, right? Wrongo! Let’s move on to part II of this and I’ll explain more. For now my tea is ready to brew. See you in a bit!

What? You Want to Leave Treatment?

Wednesday, September 22nd, 2010

I got a call last Friday from a friend who said in her message that she told her therapist (it’s never “analyst” or “psychotherapist”) that she wanted to cut down her treatment to having sessions every other week. She said the therapist didn’t agree so she wanted to talk to me & explain her reasons for wanting to do this. She wanted me to call her back over the weekend, if possible, so she could explain it to me.

I didn’t call her over the weekend. Not because I don’t like returning calls. Doesn’t matter if the call is from a friend, patient, possible referral or whatever. I didn’t call because I didn’t quite know what to say because I’m a therapist. In point of fact, I’m trained as a psychoanalyst but because of the licensing laws I can’t say that I am one (yet another story.) So I didn’t say it. But that’s my training and I do practice psychoanalysis.

I didn’t call because there’s really very little for me to say. People want to leave treatment all the time. It happens.  We all know this.

Yesterday I received a different message from her. I was in the middle of a session and couldn’t take the call. Happily couldn’t take the call. In her message she said that she wanted to leave treatment entirely and was considering not even going to her next session. She thought she’d send her therapist an email explaining her reasons. She asked if she could send me the email first (I typed “fist” there and had to correct it. I wonder what Uncle Sigmund would think of that!) to see what I thought of it, but I’d have to send her my email address so she could do that. This message warranted a response.

Like I said, people leave treatment all the time for any number of reasons. We know this. We also know that the reasons aren’t always what people say they are. This is part of the work. I reminded her that I’m a therapist and, as such, I can’t go along with ending treatment with an email. I don’t like getting emails from my patients. Lack of confidentiality and all that. I tell patients not to email me. I don’t email them even if they do. I respond with a phone call. That’s another story.

Ending a course of psychotherapy (or psychoanalysis) isn’t like deciding not to see your doctor or dentist. There’s a more intimate relationship that’s been forged (or was supposed to be forged) during the treatment. Calling your therapist to say “It’s over” (or sending an email to say much the same thing except at greater length) is not “the easy way out.” We have an obligation to make sure that the loose ends that can be tied up are. We also want to know and discuss what is really going on.

In some ways it’s like telling telling the surgeon who’s just finished removing your appendix to not bother closing. No stitches for me. I’ll be fine, thanks. Just send me the bill. Anyone who would do that would be considered a bit (or a lot) bonkers. And psychotherapy isn’t like surgery for a ruptured appendix. You don’t have to have it. You can go through life the same as you’ve been going through life and you can keep getting the same results. It’s also not like recommended surgery for which you get a second opinion, at least not once you’re finished shopping around for the therapist who works best with you. One therapist can’t know what your treatment was like with another therapist, no matter how much you try to explain it. That’s why someone asking me to listen to his or her reasons for leaving a current therapist is not something I’ll do. I can’t know what went on. The reasons may or may not seem valid but WDIK, y’know? I can’t listen as “a friend” because of my profession and I can’t treat a friend for the same reason. If this were a professional consultation I’d be saying the patient should (one of the few times I’ll use that word) swing back around and talk with his or her current shrink to settle up what’s unfinished.

The process is called “termination.” It means an ending. It’s a process. It’s that simple. Don’t just go away mad and don’t just go away. You owe it to yourself and your shrink. I’m not here to talk you into staying in treatment. I may try because of work left unfinished. You and I may agree that it’s time to go (it happens – really!)

Sorry friend. I can’t tell you anything other than I did. Not showing up isn’t the easy way out. It’s just messy. Doesn’t mean you can’t skip out, just that it’s leaving before the party’s over without saying goodbye.

Credit Cards & Psychotherapy Fees

Tuesday, July 27th, 2010

Credit cards for psychotherapy fees? No. I don’t. It says so right on several of my listing pages. If you haven’t seen them you can find them at Help Pro:


Psychology Today’s find a therapist:

There’s another couple of them floating around out there, including one where I can be rated by patients (no one’s gotten there yet – be the first on your block!) In any case, no, I don’t take credit cards but….

There was a recent discussion of the “ethics” of accepting payment of fees via credit card on one of the list serves I subscribe to. I mean, why shouldn’t we? Your dentist does. So does your MD, well as every other professional and, in fact, everybody including the butcher & baker. What’s the big deal about “ethics?” It’s just another way of paying for services, right?

Wrongo. Money & psychotherapy (psychoanalysis) have been inextricably linked ever since Uncle Sigmund was writing out his confusion into clarity (and then confusion, but that’s another story.) Credit isn’t a payment by you to me. It’s you asking your bank to pay me. But wait, I hear you ask, isn’t that just like paying you by check? No (unless you’re using overdraft, and we need to talk about that.) When you pay me by check you’re paying me out of your account.  It’s your money. Credit is somebody else’s money (OPM.)

I know, I know. Everybody does it. You pay for everything with credit. It helps you keep track of your spending. You couldn’t pay for it otherwise (again, we need to talk – see the next blog post.) Well, no, they don’t. Not everybody. Besides, it puts somebody in between us (is that what you want?  We really need to talk.)

It’s not that I’m hungry for money or my cash flow needs an infusion of ready money. It removes you from the interaction of us, and that’s just where we need to be.In case you haven’t figured it out, I’m kinda old school about some things and the relationship between us is important to me as a really vital part of the work. Got it? Money is one of the ways that people exchange energy between each other and also one of the ways, one of the really frackin’ big ways people show what’s important to them. Credit changes that. It removes the exchange between us and makes everything equally (un)important.

Yeah, I know. Who wants to be bothered carrying cash or checks around? Good question. Wish I had an easy answer for ya. As for the “ethics,” that’s also part of the next blog.

Catch ya next time.


Tuesday, April 20th, 2010

A man walks into a psychotherapist’s office and says, “How am I?”

Why start out with a dumb joke? To get it out of the way, of course. There are loads of psychotherapist/psychiatrist jokes out there, so there’s one and that’s done. Now I can get down to the business at hand:

Out Of My Mind is a blog by a private practice and consulting psychoanalytic psychotherapist in New York City and for the general community. Some of what you’ll find here is written to and for other clinicians but mostly this is going to be aimed at informing the general public about trends in mental health practice, suggestions for ways to reduce stress or recognize stressful situations and other stuff about how “life issues” affect day-to-day effectiveness. I’ll  also be posting my  opinions about issues such as the state of delivery of mental health services, privacy practices and the situations that arise,  and sometimes just talking about a movie or book that might tie in to mental health issues (believe me, everything ties in to mental health issues, whether most people think so or not.)

I’ll be talking about “the unconscious,” sometimes meaning the people who seem to be, or are, walking around in their sleep.  I’m going to try to keep the clinical jargon to a minimum because I’m not a fan of speaking in code, though sometimes it may be unavoidable.

I do want to be clear at the outset that this is going to be an offering of information and my opinions and, unless stated otherwise, it’s going to be me speaking out of my head. This is not intended to substitute for psychotherapy and is not offered as treatment for any mental health issues except maybe my own need to speak my mind. It also in no way is purported to represent the views of the host for this blog or any of the intermediaries who get these words to you. This is me sharing my thoughts, ideas, and perhaps some useful information to you.