One of the first questions a new potential client asks is, “Do you take insurance?” It’s a fair question. Finances are a big part of our reality and often drive what support we seek. I choose not to take insurance, but not for the reasons you might initially think.
In my first career as a special education teacher, I saw clearly the impact of labels and pathologizing. When we see people as their label first, it colors our perception of them. And while we can make an effort to see each student or client as people first, acknowledge the benefits labels provide, and make an intentional effort to focus on people’s strengths, labels have an insidious way of staying in our minds.
We’ve all heard about the importance of first impressions. Those first moments with a new person shape how we think about and interact with them, even as we learn more about them. In school and medical settings, the first impressions people receive of us are often through records written about us by others. When those written records focus on labels, diagnoses, and needs, people’s first impressions of us are often that we are broken or in need of fixing. They come to see us as “PTSD,” “Bipolar,” or “Gender Dysphoric” first, and as the person we are second.
Working with insurance companies requires counselors to pathologize clients. To qualify for services, the counselor has to immediately label you with a diagnosis and continue to monitor symptoms to ensure the accuracy of the diagnosis. There are ways to work with the system that feel better – it’s common practice to diagnose everyone with an adjustment disorder initially, and only add more intense diagnoses if necessary. But it still requires focusing on lacks rather than strengths. And some companies ask for further information to confirm the necessity of the services. Once a diagnosis is in your insurance records, it becomes part of your permanent medical record. Even if a diagnosis, such as PTSD, is resolved, it stays in your record.
The way I choose to work with clients is strengths-based and very individual. I like to take time to deeply get to know each person, the texture of their lives and the complexities of their experiences. I am less interested in the diagnosis and more interested in their current challenges and joys, fears and hopes. I want to know what brought them to counseling, the skills that have supported them to this point, and the areas of growth where I can be of support.
Selecting a label or diagnosis early on can inhibit this process. The way our brains are wired, once we have an idea in our minds, we unintentionally use that information to make sense of new information in our brains. Categorizing with known information to make sense of new or unknown information.
Used mindfully, labels can be incredibly helpful. They help us make sense of what is going on, connect with the common humanity of our experience, and feel less isolated or crazy. In choosing to support clients outside of the insurance company requirements, I am free to use labels only if and when they support each individual client’s experience.
Many of the people who reach out to me choose to go ahead with counseling and pay privately. There are financial support options available. Some clients use health savings accounts or submit receipts to insurance companies for out-of-network reimbursement. I do offer a sliding scale, and have a limited number of monthly appointments for people who need a significantly reduced price. As with any of our self-care practices, there are a lot of aspects to consider. Payment is one of them. Finding the right fit for our individual needs is another.
If you are reading this and you’re looking for support, I hope it helps you think about what matters to you in the process of finding the right counselor. There are a lot of different styles and beliefs out there. Just as there are a lot of different people seeking counseling support. If you think I might be a match for you, I’d love to talk with you and explore the possibilities.