- Mental Health
SO YOU WANT TO BE A THERAPIST?
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SOME OF THE IN'S AND OUT'S OF THERAPY
Oh, excuse me. I thought you said you wanted to be a therapist! Oh, you just want to know what therapy is like. Well, you mean from the perspective of the client or the therapist? Those can be really TWO different experiences. It’s great when the therapist and client have an experience that is, in some way, in sync, but being in sync or mutually satisfying is not a particularly good measure of positive outcome. About twenty years ago, I read a really funny news item in The World Weekly News , which was one of those Tabloids you read as you check out of the grocery store. The news item told of a very old German therapist, Docta Vellstein (I made that up), who died in his office, but no one noticed. His numerous clients continued to come for their weekly appointments and get what they always got and what they really liked. He sat there, rocked in his chair, and just LISTENED. Alive or dead, they loved him, PAID him, and left his office quite satisfied week after week. Believe me, that is a very funny story, especially for me as a therapist.
So are you wanting to make an appointment? Oh, you’re just asking some questions for a friend who says he’s interested but first wants to know what it’s like. I see. Could that friend be you? Just kidding! Yea, some of my best friends are always asking me for their best friends. I prefer people skip the inquiry, and just make an appointment! I’d love it if the front of my office resembled a movie theatre. You know, there would a line, a LONG line.
I’ve actually considered having an open door day where you would just show up, whenever you wanted, and join the group that would be in session for the entire day. We’d give you some kind of metering device that would track your start and ending time!
Now, if I could pull that off, it’d really be cool if there was a line of folks at the door, waiting for someone to leave, so they could also have some time in the group.
Okay, so I digresssed with three s ’s no less. You don’t want to be a therapist, you just want to know something about therapy. Like what, for example? Like how much it costs? Well, I can tell ya, right now, it doesn’t cost as much as you spend on those cigarettes or as much as you drop at the casino, or as much as some of you spend on single malt scotch, or as much as some of you spend on Ebay, or as much as some of you spend having your hair done and colored, or as much as you might end up giving to a lawyer. It certainly doesn’t cost as much as you spend on cell phones and cable every month. Certainly not as much as the payment on that new car! Oh, you’re leasing. Well, it doesn’t cost as much as you’re going to pay when you turn that leased car in or have to buy it! It definitely costs more than you give the homeless people standing at the end of the off ramp, which I know for some of you, is zilch!
You know, a guy asked me once to lower his fee because he had just bought a new car, a new house, and had to hire a lawyer to protect himself against his wife who was suing him for divorce. Now what really was insulting about his request is that the judge, who was hearing the case, required he and his wife attend therapy together, and they were to split the fee, which, at that time, put his portion of the fee at $37.50! What the heck did he want me to trim off of $37.50? There’s not enough room in this blog to tell you EVERYTHING I wanted to say to him, but I did keep it simple, very very simple. I said, NO!
That’s something you will definitely learn when you come to therapy. What do you mean, what? TO SAY NO. That’s a clue right there, you, like so many other folks, don’t know how to say NO to what you want to say NO to. You say yes when you want to say no, and then bitch about it later as if you’re some kind of a victim. Well, get your butt in here, immediately. We’ll get that taken care of QUICKLY. I cannot tell you how many times a week, I get rocks thrown through my front window with notes attached that say something like, "So you taught her/him how to say NO, did ya?" I don’t even bother repairing the window anymore. I replaced it with a big piece of plywood with a target painted on it! In the bullseye is a thumbs up and the word YES!
So you want to know, for this friend of yours, what my fee is? Well, it’s pretty crazy how the fee works. If your friend has medical insurance with a company for whom I am a preferred provider, the insurance company basically tells me what I can charge. It’s called the "allowed amount." Your friend will have a COPAY which is a portion of that allowed amount. Sometimes the copay is very minimal, like five or ten dollars. Or the copay could appear minimal because clients imagine that the insurance company pays top dollar. What they don’t realize, and I’m not suppose to tell them, is the insurance company could set the allowed amount at $50.00 and the copay at $35.00. I am sometimes tempted, in those cases, to try to negotiate with the client just to pay me $50.00, and save myself the time and money involved in billing for $15.00. But, to keep "cool" with the insurance industry, I don’t. I appreciate the Aetna PPO plan whose allowed amount is 60% of my customary fee. Hey, this is even better. Anthem Blue Cross’s allowed amount is 50% and Health Net’s is 40% if it is a family session or 33% if it’s an individual session. My agreement with the insurance companies, and the law, prohibits me from collecting the difference from the client.
I am not complaining, really I am not. I appreciate ending up with a full schedule just because I am a preferred provider for a company that pays me only a fraction of my fee. I know, quite a paradox and quite a conundrum. I’m sure there is some economic principle that makes it all make sense.
So what happens if your friend does not have insurance with a company I am affiliated with or has no insurance period? And there are folks, who for privacy reasons, choose not to use their insurance. Well, here’s my schpeel.
I have a sliding scale that runs from $150.00 to $95.00. I have no criteria for how a person fits into the scale. You pick where you think you fit in. Think about all the goods and services for which you do not think twice about spending between $95 and $150.00. Now if for some reason, that scale does not work for you, then tell me what will work for you. Tell me what you were planning to spend on your therapy. And we will figure out some amount that works for both of us. This method has worked well for me for the past five years.
I actually believe that the service I provide, given my experience of forty three years in the mental health field and twenty eight years in private practice, is a 150 dollar value. Especially when I compare my service to what other services and products and experiences for which people are more than willing to pay $150.00. Literally, as I’m writing this blog, I’m listening to someone on the The Splendid Table , an NPR food program, talking about a restaurant where you can easily spend $150 dollars per person! So there you go!
I even set aside two pro bono time slots per week. However, whenever I have been willing to see a client for no fee (pro bono), they never show up. Go figure! Yes, I do understand embarrassment and shame, but fortunately or unfortunately, I am the kind of person who is quick to accept another person’s generosity. I do not consider it "charity." At any given moment, any one of us, rich or poor, can have a need we cannot afford to meet, and we become dependent upon the generosity of someone else. In part, that’s what makes the world go round! So I have a hard time understanding why someone would not take advantage of my willingness to see them pro bono and get for themselves some healing and ultimately a better and richer life.
The economic "downturn" or whatever it is called, has had a HUGE impact on my business since 2007. It’s been a slow process getting back on track. I am still about a month behind with utilities and with most creditors. But my practice is very dear to me and worth the effort of getting back to where I was or beyond.
So what else do you want to know about therapy? Yea, I know. NOTHING. You just want to know the cost. So are you in or out? Hey, I tell ya what. For FREE, I’ll tell you what’s going to happen if you come. Oops, that’s right. If your friend comes!
When your friend finally has the courage to make an appointment, and then keeps the appointment, and then gets off the couch in the waiting room and walks a few feet down the hall to the therapy room, and sits down on a really really cool couch, your friend is going to gradually feel SAFE. Very very safe.
So that’s where I put my effort as the therapist. I want you to feel safe. I enjoy creating an emotional climate where you feel accepted by me, and you notice yourself, in turn, accepting me. You come to this unspoken awareness that you and I are no better or no worse than any other human being on the planet. You begin to get it pretty quickly that I am not going to judge you, nor fix you, nor get you back on track like you’re some kind of idiot or worse crazy person. You will notice that the couch in the therapy room supports you sitting tall, and you soon realize that you experience yourself being grown-up in the therapy session. When you look at me, you might even be an inch or two above me as my chair seems to sink a little bit each day. But for all practical purposes, you get it that you and I are on the same plane. We are equal people, each with our strengths and limitations. Each of us has a best foot forward and a bunch of secrets that we try desperately to keep hidden. And it’s not that I share with you any of my dark side. I don’t, but you just get it from the questions I ask or the hunches I throw out that I have a lot of my own "stuff" that I am working on, just like you are about to begin working on your stuff.
You gotta be very grandiose in your thinking to believe you have some very unusual, one-of-a-kind stuff. I mean everyone picks his or her nose on the freeway, but in the privacy of their car where no one will see them. Everyone lets go of one of those deadly farts in the grocery store or worse in church. Everyone fantasizes about someone they love disappearing with or without help. Everyone struggles with some form of addiction, and those who don’t, struggle with honesty and self awareness and a narcissistic need to be perfect. Even what you might think to be the most heinous behavior, the most disgusting behavior, the most perverted behavior, you will be surprised that there is a support group for YOU with your unusual and rare behavior. Our ticket into the universe is being human, not perfect.
So it will not take long for you, oops, your friend, to begin to feel very safe just being who he or she is.
And, if you are into religion or spirituality or both, remember that verse from the New Testament, "Be as perfect as my heavenly Father?" The original Greek word translated as ‘perfect" actually means grown-up. So be as grown-up as my heavenly Father. So yes, the universe has a mandate that we grow up, and growing up is actually a lot more difficult than being perfect, but it is also a lot easier. Now there’s an awesome paradox! So tell your friend to make an appointment so he or she can feel safe, perhaps for the first time in their life. Make an appointment so he or she can have the wonder-filled opportunity to own his or her humanity, and have a chance to begin growing up. What’s awesome about being all growed-up is you can’t get into trouble anymore.
I do give clients feedback and sometimes, lots of feedback. But I always ask first. "Do you want some feedback from me?" Sometimes, a client will say yes, but. And I’m always glad I ask for permission, so to speak, because I want to respect the "but."
My feedback does not come from a bag of old tricks or books. My feedback comes directly from what you tell me you are struggling with. And I ask lots of questions. For example, "So what will happen if you say, ‘no?’....and then what.....and then what....and what’s so awful about that?....So what will happen if you burst into tears?....what will happen if you tell him or her just how angry you are?....And what’s so awful about that?" So we sort out what your strengths are, what you are capable of doing, what blocks you, what thought processes and fears block you from DOING and BEING who you are. When the session is over, I often hit the Staples button, "That was easy!" And as easy as it might have been, it truly is not easy. Being a human being is a tough road to hoe, even though, at the same time, it is a wonder-filled road, full of joys, pleasures, and accomplishments.
I work with individuals, with couples, with families, with children and adults. My youngest client was 2 years and nine months old. My office always smelled of poop after his session! I’m not sure if that meant he was feeling safe, perhaps just being that age, or like most kids, they gotta leave a little something behind where ever they go, check out every bathroom between home and whatever your destination is! Or maybe he was trying to tell me, in his own way, that his life without his Dad, was for the sh-ts.
I enjoy working with kids and teens, and I tend to be totally off the wall and off the cuff with little people and teens. Once we laugh and be silly with each other, whatever else needs talking about comes out with ease.
Well, I think I have told you enough to help your friend decide whether or not he or she wants to make an appointment. I will be posting some other blogs about therapy in the near future. Look for them and tell your friend.