Chicago therapist Rachel Kazez understands exactly how challenging navigating the mental health system can be. In addition to providing therapy to families, couples, and individuals—with a speciality in young adults—she founded and operates a service called All Along, which specifically helps people sort through the confusion to find the right services for them.
While she knows how overwhelming the hunt for psychological care can feel, she's optimistic that anyone can manage it with some basic prep. “It might take work, but it’s possible for everybody to find good mental health treatment that they can afford,” she says.
Here are a few of the most important steps to take.
Where do I even start when searching for a therapist?
Recognizing you have challenges you can’t handle on your own is really all the information required to start reaching out. Sure, it might be helpful beforehand to put some thought into what kind of therapy or therapist you’re looking for, Kazez says, but starting your search can lead you to answers you didn’t even know existed.
“You don’t have to figure this out all by yourself,” she says. Even if the first place you call or visit doesn’t treat the types of issues you’re dealing with—for instance, if you find out they specialize in veterans or younger children—the staff might still be able to recommend other resources.
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And once you find a practice or clinic that can offer you a slot, they’ll offer even more guidance: “Often the process of doing an initial assessment or intake or whatever it’s called at the place you’re going, that process is about clarifying your needs and preferences for treatment and even referring you out somewhere else if that’s what you need,” she says.
What kind of therapist should I look for?
While you don’t have to get hung up on it in advance, it may help to understand that when it comes to mental health, there are a wide variety of providers. Psychiatrists are physicians—MDs or DOs who can prescribe medications—while therapists who have PhDs or PsyDs can’t write prescriptions (though they might team up with a doc who does to manage your care).
People with master’s degrees in psychology, counseling, or social work can also practice on their own after about two years, provided they have the correct licensing in their state. They might be called licensed clinical social workers (LCSW), licensed mental health counselor, licensed clinical professional counselor, licensed marriage and family therapist, or some combination of those terms—all indicating they’ve met state standards for education and experience. At some clinics, Kazez says, a case manager might help you connect with a therapist and also provide some supportive counseling.
I have insurance. Does it cover therapy?
Most employer-based health insurance plans cover mental health services, and all plans purchased through the Affordable Care Act’s marketplace must include it (it’s what the government considers an essential health benefit). So if you have coverage that does, that’s often a good place to start, says Angela Kimball, national director of advocacy and public policy at NAMI, the National Alliance on Mental Illness. Check your insurance company’s website or call the number on the back of your card and ask for a list of mental health service providers in your network.
Websites like the American Psychological Association and Psychology Today offer online directories where you can search for therapists by area, speciality, and types of insurance accepted. Often, there’s a brief profile, too, which can help you gauge whether you might click with this person and their approach, Kazez says. For instance, do you want a therapist who’ll direct you through a series of steps toward an end goal, or someone who’s more likely to listen and reflect back to you as you sort through your issues?
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Of course, you’ll want to call and double-check that they take your specific plan—they might take some plans offered by your insurance company and not others, or the information the company gave you may be outdated. Be especially cautious if you have Medicaid for insurance, Kazez says. Often, Medicaid plans are organized by what’s called a managed care organization. To be covered, the provider you see not only has to accept Medicaid, but also work with your specific managed care organization. Again, the staff at the offices or clinics you contact can help you sort through all this.
One note: Just because something’s covered doesn’t mean it’s free. You’ll typically have a flat fee called a copayment for each visit. Depending on your plan, coverage for therapy visits and also for bigger expenses like inpatient stays might not kick in until you meet a yearly minimum called a deductible, meaning you’ll have to pay more out-of-pocket at first before the flat fees per visit kick in. Your insurance company can provide specifics.
Do schools or employers offer therapy?
If you don’t have insurance, your plan doesn’t cover mental health services, you can’t find a therapist in your network accepting new patients, or you can't afford the copayments or deductibles, you still have options. One way to start is checking out the resources immediately around you. If you’re still in school, visit your campus counseling center; services there are usually available at little or no cost to students. Working? Some employers offer employee assistance programs (EAP) that include confidential counseling—ask your human resources department.
I need something a lot cheaper. What else can I try?
Online searching can also yield a wide range of options. Plug in “community mental health clinic” or “low-cost counseling” and the name of your town or a nearby city. “You might be surprised by what pops up,” says Paul Fugelsang, a licensed professional counselor in Asheville, North Carolina, and executive director of the non-profit Open Path Psychotherapy Collective. You can also search for the chapter of the National Alliance on Mental Illness (NAMI) in your area; staffers there may be able to connect you to providers.
Another search term worth trying: “sliding scale.” This means a therapist has a standard rate, but offers at least some slots at a lower fee for people who fall below certain income levels. You may have to provide some level of documentation about your financial situation, but doing so can result in a substantial discount.
“Many therapists consider it an ethical responsibility to see at least a couple of clients that are pretty low-fee,” Fugelsang says. His Open Path Psychotherapy Collective has gathered about 5,000 such providers who’ve pledged to offer treatment for $30 to $50 for individual sessions, after people pay a one-time, $49 membership fee.
The site lets people search by ZIP code before they join—and the therapists don’t have to be as close by as you might think. “Luckily the way it works in most states is that as long as the therapist and the client are sitting in the same state, it’s legal for the therapist to do online work,” he says. So even if you’re in a far-flung rural area, you can chat remotely with your therapist, a method he’s found works very well for many of his clients. You can also ask for recommendations for therapists from your doctor or from friends and family members you like and trust, then call to inquire about their rates and sliding scales, Alibrando says.
You can also call your closest hospital or university with a medical school or psychology department. Often, they’ll offer lower-cost or even free counseling with trainees or students. Of course, experience counts when it comes to therapists, says Sam Alibrando, a clinical psychologist in Pasadena, California. Experience, however, isn’t the only indicator of quality, he says.
In some cases, there may even be upsides to seeing a trainee, Kazez says. “Even if they have fewer years of experience doing the work, they're also much closer to their education. They’re getting the most up-to-date education about how to do good counseling and they're usually getting a lot more supervision and consultation than people who’ve been in the field for a while.”
I have really specific issues. Do I need to see a specialist?
If you’re coping with common complaints like anxiety and depression, nearly any therapist will have training in how to guide you. If there’s an added element to your experience, however, you might find free or low-cost resources through organizations that specifically focus on it, Alibrando notes.
For instance, RAINN (Rape, Abuse & Incest National Network) works against sexual violence and offers a free hotline at 800.656.HOPE (4673), among other services. The Anxiety and Depression Association of America offers a directory of low-cost providers, as well as advice on affording care when cash is tight.
If your mental health challenges are highly specific—for instance, post-traumatic stress disorder (PTSD) or eating disorders—you may want to start there to ensure you’re finding someone specifically trained in those areas, Alibrando says.
Regardless of what lies at the root of your concerns, there are many ways to find help fast in a crisis. The National Suicide Prevention Lifeline provides free, confidential support 24 hours a day, 7 days a week via chat or phone (1-800-273-8255); or text HOME to 741741 to reach the Crisis Text Line. And if the situation’s life-threatening, you can also call 911.
What are my other options?
In some cases, there’s no substitute for one-on-one treatment from a mental health care provider. In other situations, however, different types of services can supplement or potentially even replace therapy. “There are a lot of options that aren't just sitting down with an individual therapist in one office that are often a lot cheaper and can be really powerful and helpful,” Kazez says.
Group therapy, for instance, combines the guidance of a professional with connections to others dealing with similar issues. Programs such as Alcoholics Anonymous help many with substance use disorders. Religious organizations often offer faith-based counseling or support groups. Hospitals, clinics, or non-profit organizations may offer peer-to-peer support, a link to someone who’s been through what you’re going through, Kazez says.
What if I hate my therapist or can't afford to go anymore?
Sometimes, a given therapist’s approach doesn’t work for you—and every once in a while, you might run into a mental health care provider who just plain isn’t good at what they do, Alibrando says. Or maybe you find a therapist you like only to discover, over time, that you can no longer afford their fees. Perhaps you’ve tried a few times and just don’t think therapy’s your thing.
That’s OK—but that doesn’t mean you have to give up on feeling better. “There are a lot of different ways to get help with your mental health, and help with your mental health doesn't have to mean therapy,” Kazez says.
Group or peer-to-peer options, or even something as simple as joining an art class or sports team, might improve your mood, forge beneficial relationships, and help you learn communication and problem-solving skills. Or, try telling your therapist you'd like to come in once a month rather than weekly or biweekly, and ask them if they have a workbook they'd recommend—there are many evidence-based options targeting issues such as anxiety, depression, or anger.
And if things reach the point where your concerns are more serious or troubling, you can always resume your search. “There are absolutely ways to go about finding treatment and making it affordable,” Kazez says.
What kind of health plan should I get if I need therapy?
Definitely one that covers mental health treatment—though again, most do, including all of them available on the Affordable Care Act marketplace. If you’re choosing between different employer-based or public plans and already have a therapist, check to make sure that person’s in-network, or that you can afford to pay the out-of-network rate if not. The provider’s billing department can be a crucial source of information about whether one plan’s better than another, so call them with questions before you make a final decision, Kimball suggests. If you’re taking medication, also check that your prescription is on what’s called "the formulary," or the list of drugs your plan will cover.
If you don’t have a therapist yet, you might have to go through the process of scoping out networks and potential providers for each plan you’re considering. Sure, it’s a bit of a pain—but if there’s a big difference between plans, it might end up saving you a substantial amount of cash.
Will my parents or employer find out if I go to therapy?
If you’re on your parents’ health insurance plan, they’ll probably receive an explanation of benefits (EOB) or similar statement in the mail or online saying that you’ve been to therapy. But with a few important exceptions, such as plans to hurt yourself or others, everything you say to your therapist is confidential.
If your plan’s through work, your bosses won't find out unless you tell them. Companies get big-picture information about the cost of employees’ health care consumption, Kimball says. However, the specifics of your medical records—including the fact that you made therapy visits—are protected by what’s called the Health Insurance Portability and Accountability Act or HIPAA. They can’t be shared without your consent.
What happens if I need to take extended time off from work?
The same rules apply for mental health issues as for physical health problems. “They are both medical concerns that someone can approach human resources about to discuss extended leaves of absence, for example an FMLA leave like when someone is injured,” Kazez says, referring to the Family and Medical Leave Act. (It's worth noting that, in most cases, only a certain percentage of your income may be covered—not all of it.) Your therapist may need to provide documentation to your HR rep for time off, but at most companies, that person can act as a confidential go-between if you don’t want to go into detail with your manager. And just as with any other health issue, if your employer doesn’t provide reasonable accommodations, you can escalate things to higher-ups, get your provider involved, or possibly take legal action.
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