Should I quit therapy for financial reasons?

August 19, 2010 9:29 AM

Should I quit therapy for financial reasons?

I am a 27-year old female graduate student. I have been in therapy for about 16 months with someone who I like and pretty much works for me. I’ve learned a lot, developed some new skills, and gotten TONS of perspective on the original reason I started going. My insurance situation is changing on September 1, and the cost to see my therapist is going to almost double, to an amount that would be a significant hardship for me to absorb (new insurance company, therapist is now out of network.) My gut reaction is to just quit. I went through a period a few months ago where I thought about quitting because I wasn’t sure I was getting enough benefit for how much it was costing me, but ultimately decided to stick with it for a while.

Pertinent information:

-This is the first time I’ve gotten mental health care. I have nothing with which to compare this person/experience.

-My current cost amounts to 9% of my after-tax-and-rent income. My new cost to see this therapist would be about 17%.

-I am not acutely mentally ill, but I have had episodes of major depression in the past.

-The work I’m currently doing in therapy is interesting and helpful, but doesn’t feel essential or life-saving.

-I have a strongly supportive and stable relationship and friend/family network.

-It is extremely easy to enter mental health care through my student health center, so if something came up in the future, I could take care of it rapidly.

-I have gotten to the point where I have very good rapport with this therapist, and our relationship has developed to the point where we can achieve some insight during most sessions.

-I do not want to find a new therapist who is in-network because 1) I have been told that it would be hard because few providers accept the low reimbursement rates of my new insurance plan and 2) I will be leaving the area in less than a year and I don’t want to invest a lot of time in developing a new relationship just to cut it off soon after it gets good and 3) it is pretty likely that my insurance will change again in March and that new person might be out of network again.

-My therapist understands my finances and insurance and has offered to find some kind of compromise between the current rate and the new one. I appreciate this, but I also HATE HATE HATE this kind of negotiation, especially with people I know. I also really feel like I can’t pay much more than I’m paying now and I would feel extra uncomfortable if we couldn’t achieve a compromise. I’m also pretty sure that if I enter into a negotiation I’ll end up agreeing to pay more than I can afford.


So, should I quit or try to make a deal? What am I not considering here? What am I considering that I shouldn’t be?

Thanks for your input!

posted by juliapangolin to Health & Fitness (20 answers total)

You could go half as much? Instead of once a week, once every two weeks? But before you consider that, negotiate a new rate! Your therapist offered, I'm sure her office does that all the time.
posted by ThePinkSuperhero at 9:34 AM on August 19, 2010

I would negotiate, but keep quitting as an option. I'm considering quitting therapy for financial reasons myself right now. My plan is to check in with myself once a month or so to see if I feel like I need it. If I do, I'll probably look for someone who's on my insurance, unlike my current therapist.
posted by ocherdraco at 9:40 AM on August 19, 2010

Definitely see if you can negotiate a rate and don't feel bad about it. She's not a "person you know," she's a professional providing a service (albeit one more intimate than, say, your mechanic,) and negotiating the bill is standard faire.
posted by griphus at 9:40 AM on August 19, 2010 [1 favorite]

You can also go back if you need to. You don't have to either go or not go. A good therapist should work themselves out of a job. They should give you the tools to deal with the stresses of life.

I agree with ocherdraco in that "checking in" every so often might be good, if needed. But after a while, for me at least, I will go, get things resolved and then feel like I'm wasting my time/ the therapists time, and my money.
posted by TheBones at 9:45 AM on August 19, 2010

You wouldn't be "quitting." People reevaluate their terms of therapy all the time, for all kinds of reasons. Your big ones now are financial and also, based on the fact that you were considering leaving a few months ago, emotional need. It's great that you've built a rapport with your therapist and you don't have to lose that. Now you have a faithful person to go to in the future for "tune-ups."

That said, if you want to keep up the frequency that you have now, definitely consider negotiating a new rate! I agree with TPS that your therapist probably does this all the time.
posted by Katine at 9:48 AM on August 19, 2010

Sure. You can always go back. (I'm a therapist, though not your therapist.)
posted by OmieWise at 9:51 AM on August 19, 2010

Why can't you try the student health services?
posted by k8t at 9:55 AM on August 19, 2010

An insurance company negotiates rates with a provider. They often get a significant amount less than their actual fee in reimbursement from the insurance company. It's entirely possible that when she offers to compromise on her rates, she *won't* be taking in a huge amount less than she'd be getting otherwise. (Check out your EOB's; see how much they bill, and how much they're actually paid. There's a reason providers sometimes have significantly lower "cash rates.")

So hey, definitely try discussing the fees and see if you can come up with something you can afford. And if you can't, you can't--but at least you'll have checked it out to see.

I've found that going to therapy on and off can be really helpful to me: I go for a while, take some time off to digest it all, then got back again later. But if you have a good relationship with this therapist and you feel like you're still accomplishing things in therapy, I think it's worth it to keep going for a while longer.
posted by galadriel at 10:08 AM on August 19, 2010

It sounds like you'd be alright without it now, which would be my biggest factor after finances. If it helps, my therapist and I have had to re-evaluate my costs several times (we've gone through everything from free to as much as $75 a session), and it wasn't a negotiation like at a used car lot. It was more like she said, "we both agree it'd be helpful to have you in therapy x times a week. So would This amount be doable for you?" and I said yay or nay.

You therapist knows your limitations, so if you wanted to make a couple of proposals (coming half as often or less vs paying xx amount per session) it can happen without the Hateful (I feel ya!) quibbling. But it's also ok to end therapy for now.
posted by ldthomps at 10:19 AM on August 19, 2010

First: negotiate. They've offered to do this. Rapport with a therapist is important, as is finding a good one. (Unfortunately, they aren't all good at what they do, and it sounds like you've got a good one.) However, you can't afford what you can afford. Don't worry that they'll take it personally. (Psychologists have to separate the personal and professional aspects of their jobs. It'll be OK.)

Second: I don't think you'd have to be any kind of crisis to get counseling services from your university. Having a history of depression should be sufficient, and you're already paying for it. (Call them and ask, but I don't think so.) Your university's mental health services should have a good number of counselors available. Describe to them what you've been doing with your current therapist. If they assign you to somebody you don't get a long along with or doesn't seem right for you, don't be afraid to ask for a different counselor. Like I said rapport is important. They get that!
posted by nangar at 10:24 AM on August 19, 2010

You might see if they would give you in-network rates for your out-of-network provider. I was in a similar situation recently and my therapist told me that sometimes insurance companies consider paying for OON providers in cases where it's important that the patient stay with the same provider for consistency of treatment. However, this was shortly after a serious recurrence of my depression so there was possibly more justification for staying with the same therapist than there might be in your case. But it couldn't hurt to ask!
posted by Colonel_Chappy at 10:26 AM on August 19, 2010

-The work I’m currently doing in therapy is interesting and helpful, but doesn’t feel essential or life-saving.

I got to my therapist on an as-needed basis (i.e. major crisis or episodic depression). She is happy with this -- she's actually the one who suggested it. And I have great insurance that would cover weeklies if I wanted to.
posted by Brittanie at 10:57 AM on August 19, 2010

Your current therapist may not want to accept their lower rates, either, but when my therapist became out-of-network due to a change in my insurance she was able to go through what she claimed was a relatively simple process to become an in-network provider. I have no idea what her definition of "simple" is or whether this true in general or I just got lucky.
posted by camyram at 11:32 AM on August 19, 2010

Best answer: I would encourage you to negotiate with your therapist. Tell her waht you can afford to pay. Part of the APA and ACA ethical guidelines mandate that therapists not, "abandon" their clients. Even if you are under financial hardship, your therapist is ethically, morally, and professionally obligated to work with you to continue your care (Or find you a referral that is significantly cheaper). They know this going into the field and change their fees all the time. It's just part of the job.
posted by WhiteWhale at 11:33 AM on August 19, 2010

Best answer: My therapist ... has offered to find some kind of compromise between the current rate and the new one. I appreciate this, but I also HATE HATE HATE this kind of negotiation, especially with people I know. I also really feel like I can’t pay much more than I’m paying now and I would feel extra uncomfortable if we couldn’t achieve a compromise. I’m also pretty sure that if I enter into a negotiation I’ll end up agreeing to pay more than I can afford.

It sounds like your desire to avoid negotiation and conflict could cause you to drop therapy. That would be too bad! It could be that by addressing these issues, you might be able to continue therapy in your current financial situation.

So, short answer: no, you shouldn't quit strictly because of cost, so long as there are other reasons that, if addressed, would allow you to deal with the cost.

I realize it sounds terribly recursive, but bringing up how uncomfortable you are about this situation in therapy could be a really good approach.
posted by zippy at 12:21 PM on August 19, 2010

Best answer: Try to negotiate a mutually agreeable rate, even though you HATE HATE HATE it. I have clients I see for 25% of my standard rate, and I'm beyond happy to be able to financially accommodate those clients because they are regularly attending, doing good work, and really seeing some benefits from therapy (which it sounds like you have, too). I don't know all of the therapists in the whole world, but my instinct and experience is that most feel the same way I do about this. The services we provide are meant to help, not hinder.
posted by so_gracefully at 12:26 PM on August 19, 2010 [1 favorite]

If you can get a deal and you want to continue, stay. But you may find better ways of spending the money that are even more conducive to mental health: more time with friends and family doing stuff you might not otherwise be able to afford, vacations, massage, yoga classes, books, pets, etc. Just as with medication, some people need "maintenance" and others just need occasional courses to stay on track. You can always go back if needed.
posted by Maias at 12:34 PM on August 19, 2010

It sounds like you have come to terms with the idea of not seeing your particular therapist anymore. But, since she offered to negotiate, I know of a writer who said that she paid her particular therapist $5 a week when she hit hard times and eventually caught up. So crazier things have happened.
posted by kat518 at 2:20 PM on August 19, 2010

Another option might be seeing an intern. Although I think the quailty of care can be less efficient than a fully licensed counselor, it is usually significantly cheaper. When I was an intern, I saw about 25-30 clients a week for free. No charge whatsoever. Ask your therapist for any recommendations or just start calling around. Even calling a nearby university and asking their counseling department for a list of places their students intern. The only downside is that the intern will likely only be around for 6-12 months before they move on...
posted by WhiteWhale at 3:20 PM on August 19, 2010

I'd talk to her about possibly lowering the number of visits to whatever you can afford at the new rate- 1 or 2 a month, perhaps? Or as needed?
posted by jenfullmoon at 8:11 PM on August 19, 2010