Help my niece approach her parents for help with therapy costs

January 19, 2024 3:35 PM

My 20-year-old niece has decided to seek therapy for anorexia, bulimia, and depression after four years of extreme mental and physical suffering. Prior to approaching her parents about financial support for therapy, she would like me to advise her because "idk how to ask my parents for the money." If you were in my position as a very concerned aunt, how would you advise my niece to word her request?

My niece's last two years of high school, which coincided with the pandemic, and her freshman year of college were hell for her and characterized by isolation, extreme fasting, purging, self-harm, nightmares, substance problems, and traumatic experiences with relationships. About 18 months ago, she started taking anti-depressants, which have stabilized her mood and reduced the frequent thoughts of suicide she had last year, but her eating disorder is harming her health and quality of life.

My niece had been internally resisting therapy because "anorexia is the ultimate anesthetic" for the pain and trauma she has experienced. Deciding to seek therapy is a courageous step, but as college student, she can't afford to pay for treatment costs, so she will need support from her parents, who are wealthy but not pro-therapy or approachable for heart-to-heart talks. She has not felt safe sharing her problems with them because they are very focused on appearances and have gas-lighted her with statements like "you THOUGHT you had dissociative disorder." Please see my previous post:
https://ask.metafilter.com/331531/Teenage-niece-would-like-therapy-for-DPD-but-parents-not-supportive

posted by prairiecatherine to Human Relations (13 answers total)

Does she have access to mental health services through her college? I would encourage her to pursue that fully. I would think college mental health services have a lot of experience working with students dealing with all those things. I would also encourage her to figure out what her insurance covers and if she may have access to therapy services with a co-pay rather than paying outright for a therapist.

Otherwise, I think I might... talk about a wellness treatment but not call it therapy? Is she wanting to have this conversation with her parents, or just get the money? How do her finances work with her parents right now? How much does she anticipate needing?
posted by bluedaisy at 3:46 PM on January 19 [19 favorites]

I would omit the mental health aspect of this. For example:

Mom, Dad, I have some health concerns and need to seek ongoing treatment. I'm going to have medical bills that I can't afford on my own. I need your financial support.

I'm sure your niece has access to mental health services through her college, but I doubt they're as substantial as what it sounds like she's going to need.

I don't know how you're related to her parents but this is a situation where if your niece is unable to get traction herself, you should step in for...encoueragement. I would personally make it my life's work to haunt my brother about it until the day he died if I found out he was failing his child in this way. Absolutely unacceptable.
posted by phunniemee at 3:52 PM on January 19 [11 favorites]

Think about what the parents care about and whose voice they might respect and then target that. Anticipate their likely objections. Try to avoid the possibility that they will think that she is saying that it is the parent's fault.

One option that might work with some parents might be:
I've been dealing with some real problems the past few years. I've been trying to manage it on my own but it got to the point where it was interfering with my studies so I finally told my primary care doctor everything that has been doing on. She/he said that I need to take this really seriously and get professional help. I know I need to deal with this so I've researched what I'll need and it looks like it will cost xxx. That's more than I can afford - can you help me?
posted by metahawk at 4:05 PM on January 19 [6 favorites]

Is she not on her parents' health insurance still? She's not 26 yet, right? I know it can be challenging (sometimes very challenging indeed) to find a therapist who takes any particular insurance, but I'd imagine it would be a lot easier to sell her parents on a typical co-pay than on the costs of private pay.
posted by praemunire at 4:11 PM on January 19 [11 favorites]

In the US most people under 26 are still covered under the parent's medical insurance. They do not need their parent's consent to use the insurance and they can limit what the parents know regarding how it is being used. She can contact the insurance company, give them direct contact information for herself and find out what parents can see. I think that they will know that she is using it for something since it impacts certain totals (I get a report on deductibles paid to date and progress towards out of pocket max to date for everyone in my family - I don't know if my adult kids could hide this if they wanted).

If she can access in-network care for what she needs, the cost will be very much lower. If she has to go out of network, she will need to research what the insurance will pay in terms of the initial deductible and copay/coinsurance after that. For example (and this is a purely random example) it might be a $1000 deductible that she has to be pay 100% then 80% co-insurance (which means she pays 20%) There is also a max insurance will pay per session that means she will have to pay 100% of the excess charges.
posted by metahawk at 4:13 PM on January 19 [18 favorites]

Okay, I'm really sorry if this is off-topic, but maybe the way you can really help her is to look at the resources she has available on campus. If she's never been in therapy, she could probably get started there. They might well have an eating disorder support group in addition to therapists. Google the name of her college and student health or mental health services. It can't hurt for her to at least explore these options if she hasn't already. Those services should be free, paid for already in her school fees.

And she might not even realize that health insurance through her parents can cover therapy. She has likely not really had cause to navigate this stuff on her own. So I'd say that's the first and second steps, if she hasn't gone down those paths.
posted by bluedaisy at 5:34 PM on January 19 [6 favorites]

Best answer: She needs to be direct and very brief, only communicating the bare minimum.

"Hey mom/dad, can you please help me out? I'm falling short about $X per month due to some unexpected bills. Thank you, I super appreciate it! xoxo"

If they ask "What kind of bills?" she can say, "Medical bills."

If they ask "OMG what's happening? What's this unexpected medical issue? Tell us what this problem is!" she can say, "Just a routine course of treatment. Absolutely nothing to worry about. Will you be able to help me cover the bill?" or "Just something I've been putting off for a while, but I finally made time to get it looked at. So, will you be able to help me cover the bill?"

If they continue to press her for details, she can simply repeat: "Nothing to worry about, I've got it covered. Except I do need help with the bill!"

She can say this over and over again as many times as necessary, just be sure to use an affectionate and calm and slightly upbeat tone of voice, kind of like telling a toddler that it's time to stop playing and go to bed. The idea is to project total confidence and communicate something like reassurance, so that her parents get a strong IMPLICIT message that she is a fully grown adult who is handling her own personal health concerns privately.

[Note: This should not be stated explicitly because that sends the opposite message! The only people who need to remind others that they're adults are people who are acting immature.]

[Also note: She should not show even the slightest hint of impatience or anger or frustration, because these reactions communicate anxiety and fear to her parents, and that will make them anxious, and then they'll ask more and more and more questions, demanding answers to soothe their anxiety. Her best bet to soothe their anxiety and minimize questions is by adopting an affectionate, calm, and mildly upbeat demeanor when she interacts with them.]

[Further note: She should avoid "setting boundaries" with her parents, i.e. saying things like "I am not comfortable sharing more details with you" or "Please don't ask me for details" or "My healthcare matters are private"... etc. There is no need to declare to them that she's not sharing details - such declarations paradoxically invite questions and cause parents to pressure her to share details. Instead she can just... not share details. The only boundary she needs to set is with herself, for herself.]
posted by MiraK at 5:39 PM on January 19 [24 favorites]

Another option to consider:

“Mom/Dad, I’ve been dealing with some health issues. Nothing too serious, but it’s messing with my sleep and making it harder to keep up with school and everything. The doctor at campus health ruled out physical issues and suggested counseling to help with stress reduction. I’d like to try that. Can you help me with the cost?”

Sometimes parents who are skeptical about therapy are more open to it if the suggestion comes from a doctor and focuses on something like “stress reduction” than anxiety or depression. Sometimes it’s a hurdle to get a parent to see therapy as something that would help their kid rather than “something kids need when their parents do a bad job.” Making it about school stress or improving school performance can be a way to sidestep that.
posted by theotherdurassister at 8:11 PM on January 19 [17 favorites]

"There's a one-on-one program that's going to help me make up for some of the effects of the pandemic. It's a minor deal, and I don't want to go into details or talk about pandemic stuff with you guys - we've all talked about it enough for now! - but this program will help a lot with my grades and career prospects. It costs about $50 per week. Any chance you could cover that cost for me?"
posted by amtho at 9:53 PM on January 19 [3 favorites]

As a heads up if this person is in the US and on parents insurance they will be able to see the claims for whatever service. So there may be some idea that this is psychotherapy, or if in need for a higher level of care that there had been a hospitalization.

For me who was a 20 something with a eating disorder and unsupportive parents(which is probably the kindest word I could use) I ultimately ended up using student loans to deal with most of it. In retrospect I wish I had used credit cards and declared bankruptcy in the end but things are what they are and I finally got out from under my debt.

Overall getting a handle on my eating and my trauma was 100% the right move and it has made things alot better.

Blaming the school for things can be a helpful approach such a wierd bureaucracy that can impose requests on students. Also support for grades or other boring things. For example if they would provide cash for tutoring which is expensive, then shuttling the money elsewhere.

In general universities aren't going to be equipped to work with eating disorders because it is a very specific specialty. If she happens to go to a school that has some sort of program connected to a health system like a big state school there might be a program but not all of them have them.
posted by AlexiaSky at 7:26 AM on January 20

I'm struck by a different issue than trying to keep her mental health needs private from her parents. Anorexia and bulimia are serious and potentially life-long conditions, and are often difficult to successfully treat. Have her parents not noticed her weight loss? Extreme weight loss and depression would likely be something they already know about or suspect, although they probably are not aware of the extent of their daughter's mental health needs. Anorexia in some cases can lead to death. Add in the depression and substance problems and this begins to sound like a very serious situation. For the life of me I can't understand why this should be kept from them. Of course they need to assume responsibility for her treatment, which might actually include an inpatient period at an anorexia program. I can't believe she could, or should, enter a residential program without her parents knowing, unless they are truly monsters, which it doesn't sound like they are, just "anxious" which upsets your niece, who is trying her hardest to keep all her mental health issues from them. Please know that the school mental health services is forbidden to share your niece's mental or physical health information with her parents unless she gives explicit permission, so there can be no help from that venue.

On the contrary, I think she should tell them. It sounds like they know something is wrong, and become anxious about what it might be, and then press her for information, but that triggers your niece who has trouble dealing with her own anxiety.

Is confiding in her parents completely off the table for some reason? Your niece has come to you for advice - are you not advising her to talk to her parents? Also, a big issue - if your sibling (her parent) finds out that you know about these very serious issues some other way other than from you or your niece, that will create a terrible rift and add even more to the burden your niece is carrying. Think of potentially serious, even lethal circumstances that might befall your niece as she seeks to sooth her anxiety and anorexia. Drugs, suicidal thoughts, and more. If you keep this from her parents and something awful occurs they might never forgive you, and your guilt for the niece you obviously love would be crushing.

It sounds like her knowledge that her problems require more intensive therapy and figuring out how to pay for it is making her very anxious, and she is not able to handle the anxiety. But adding a session or two per week of therapy is probably inadequate, even if she is able to find additional money. You must be in her corner as her steadfast advocate without downplaying the urgency of the situation, and if the money is a serious problem, add in some resources of your own if you can to help your niece. But the solution to this must include her parents. Even if the worst happens and they abandon her you will still be there.
posted by citygirl at 9:21 AM on January 20 [5 favorites]

Is confiding in her parents completely off the table for some reason?

It's in the last paragraph of the OP. You should not include your abusers in your treatment plan, and ideally they don't find out she's in treatment at all. Things get dangerous at that point.

Assuming she is on the parents' insurance, I think she should use it as far as she can take it to get a diagnosis and referral to treatment(s), in part because she needs experts in ED and ED is generally (it's squidgy but some of the time) considered a medical problem rather than strictly behavioral, which is awesome because it tends to be more covered by medical insurance. She should do this so she has a much better idea of price tag for out of pocket and a rough estimate of the duration of various stages of treatment. She doesn't need to disclose, but she can simply refer to "treatment plan put together by my care team" and, as recommended, not diverge from that messaging.

But also non-specialist therapists can be anywhere from unhelpful to dangerous to see for eating disorders, and it sounds like she's trying to cobble her own treatment plan together - assuming the costs in advance - instead of getting onto an evidence-based track.
posted by Lyn Never at 12:15 PM on January 20 [7 favorites]

Response by poster: Thank you, Lyn Never, for pointing out "you should not include your abusers in your treatment plan" in response to city girl's post. Some readers of my post might find it difficult to relate to the extreme lack of emotional safety in my niece's home. For example, one of her parents made fun of her for lying in her room in the dark a lot during the day and told her she was a "basketcase" (but offered no support). I advocated for my niece to receive therapy when she was 15 at her request, and her parents said they would find her a therapist, but they never did.

The anguish I felt when my niece's confided about feeling suicidal in fall of 2022 was magnified tenfold by the following dilemma. If I told her parents, the information would be met with rage and denial by one parent (a medical professional) and passivity by the other. Due to emotional abuse and constant parental conflict, my niece has had dissociative symptoms since age nine. However, if I didn't share about my niece's thoughts of suicide, I would never forgive myself if she fatally harmed herself. I consulted my own therapist, who advised against involving the parents because, as Lyn Never stated, it could be dangerous. I was advised to ask my niece questions during our calls, such as if she was a danger to herself, and I had the Safety Check number to call at her university in case I learned she was in immediate danger.

Fortunately, my niece's mood has been more stable, and she has told me she doesn't feel like she did in 2022/early 2023. She realizes that she needs support for addressing her ED and the trauma she has experienced.

Update: My niece has started therapy and has resolved the problem about financial support! Thank you everyone for your comments!
posted by prairiecatherine at 4:44 PM on February 3