MyTherapistNewYork

We do not accept insurance for therapy-  And here is why.

People don’t generally expect therapy when making out their budgets.  They really don’t expect it when they have insurance coverage that covers medically necessary treatments.  For these treatments to be covered, the clinician must give you a medical diagnosis, which becomes part of an elaborate trail of paperwork (sometimes electronic) that includes any number of people involved in getting your insurance claim from the clinician to the insurance panel, and getting payment from the insurance panel back to the clinician.   While the system has its flaws that are too many to discuss here, it does generally work if you are lucky enough to have great medical coverage, and have something like strep throat.  It does not, however, have your best interest in mind when working with mental health clinicians like marriage and family therapists and mental health counselors.

I am an outspoken critic of the book that we in the mental health profession are expected to use in our work with clients called the DSM (The Diagnostic and Statistical Manual of Mental Disorders) put out every ten or fifteen years by the American Psychiatric Association.  (Interestingly, there are no statistics included in this book, despite its name.)  In it, are lists of what psychiatrists have voted to define (based on research?) as mental illness.  Nevermind that psychiatrists are medical doctors trained in biological brain diseases, not usually  psychotherapy, sexuality, couples therapy, substance abuse, eating disorders, autism, or any other topic included in the wide field of psychology.  Yet the entire field of psychology is forced to use codes from this book, to diagnose you with a mental illness, if you want to have insurance pay for part of your therapy, even if your therapy does not include treatment by a psychiatrist/physician.

Let me make it a little more clear to you by giving some real life examples.  You know all those gay kids killing themselves because they are getting bullied?  Well, if they come to therapy, I have to give them a diagnosis, probably related to depression or something called “adjustment disorder”.  So it’s not the little shits DOING the bullying that get the diagnosis, but the victim. Interested in couples therapy because your partner cheats on you?  Are you the one that calls the office to set up the sessions?  Then you are called “the identified patient” (or IP), and the “medical chart” at your therapist’s office will be opened in your name.  If you are the one with the insurance, then you are the one who will receive the mental illness diagnosis.

If you are hearing voices, or know someone who is severely depressed and fear for your safety or theirs, by all means, call 911 or check our your nearest psychiatric emergency room.  But by and large, these aren’t the folks who are going to therapy, many of whom just have problems coping with all the obstacles that come with being alive, and it is unfair for everyone involved to make them fit into a psychiatric/medical model.

Instead of using insurance for therapy, my solution has been to offer psychotherapy/counseling/coaching (whatever you want to call it) on a sliding scale.  This means that I accept a range up to what I consider to be ethically acceptable as the maximum fee (in NYC, my fee is $150, and if you do a bit of searching, you’ll find that some other professionals charge rates that are much higher).   Your rate is calculated based on the number of people in your household and your annual income, and starts at $40.

This is my calling, and my passion, and if I could do it for free, I would.  But I went to school for a long time to be able to practice my profession, and have to pay my bills, too. ( I do not want to be part of a system that emphasizes illness and not wellness, and truth be told, the amount that I would get paid from any given insurance company is not worth the hassle, anyway.) So to make my living (and pay back those student loans), I offer realistic therapy with results.  You track your progress.  You see if you are getting better at dealing with what you came in to deal with.  If you’re not getting better, why would you stay with the same therapist for years on end?  If your therapist can’t tell you exactly their plan for helping you, what are you paying them for?  If you ARE getting better, then why do you need to stay in therapy forever?  I believe so much in what I do, I have developed my practice as a training practice to offer therapists-in-training experience in offering effective, ethical, solution-focused and evidence -based counseling.  (And since 2005 have supervised no less than 30 new therapists, many of whom are now my competition.)

Chances are if you are reading this, you are not mentally ill.  Maybe no one has ever told you that before, even.  I do hope this series sheds some light on the subject of using insurance coverage for therapy, and I hope that you will want to read more about my practice and how we can help you be who you are.

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You don’t have to be married. That’s right folks, a licensed marriage and family therapist doesn’t think you have to be married. Truth is, I tend to use my other titles more than my marriage and family therapist titles, because of what that license implies. I am not pro-marriage. I am not pro-family. Now that doesn’t mean I am anti-marriage and family, so don’t misconstrue. But I do think that we get too hung up on these two particular relationship structures sometimes, especially when they imply that heterosexual, western, judeo-christian, monogamous relationships are the only relationships that exist on the planet. What perpetuates this? We the people.

I’m not particularly political. I do, however, find it so interesting on a sociological level, this whole recent exposé from a Republican candidate’s ex-wife in the media right now that includes headlines like “Open marriages and dirty tricks emerge in Republican race” and “Gingrich angrily denies he sought open marriage”. Wow. Maybe I’m way too idealistic, but really? Open marriage accusations from an angry ex threaten to ruin someone’s political career? And the indignation that follows? It boggles the mind!

Life is full of contradictions in the US today. We have (supposedly) a free market. We don’t like monopolies where we don’t have a choice- but you’d better buy American. We have (supposedly) free elections so we can decide who we want to have in our government, and they don’t get to stay there forever, only for a certain amount of time- but you get Democrat or Republican. We have (supposedly) freedom of religion, although as someone who is non-religious, I feel the pressure daily to have some sort of religion, and in this country, it had better be a form of Judaism or Christianity, but nothing too out there like Mormonism, because that’s just culty. (How many times have we heard about Mitt Romney defending his religious beliefs, when the only difference between religion and cult is who has better PR!?) So we live in a place where we feel like we can pick and choose most things, except when it comes to relationships. The choice there seems to be you can have one sexually faithful, government-sponsored, pre-defined relationship template, or not.

Do we need to talk about how many of our political representatives/morally superior folks have made headlines because of alleged sex scandals? Oh, let’s do it in alphabetical order- Barr, Cain, Chenoweth, Cleaveland, Clinton, Condit, Craig, Duvall, Edwards, Eisenhower, Benjamin Franklin, Ganley, Gibbons (not the primate, as they are usually monogamous), Gingrich (aside from open marriage, he also allegedly had an affair), Giuliani, Haley, Hart, Thomas Jefferson, Andrew Jackson, Johnson, Kennedy, Kilpatrick, Lee, Livingston, Massa (gay tickler), McCain, McGreevey (gay American), Newsom, Roosevelt, Spitzer, Schwarzenegger, Viers, Villaraigosa, Vitter, Weiner - okay, I’m bored of making this list already- check this Wiki link and the sources.

Maybe Newt was angry because he tried for an open marriage and didn’t get one. But to be angry of being “accused” of wanting an open marriage, as if it were something so morally reprehensible? Yet another example of how difficult it is for us to Be who we Are. And since we walk around feeling bad about who we are, we elect people who we think will make us better. The problem is that these people aren’t better. These people make laws that seem to come from some moral high ground, but then are unable to abide by the laws that they create. Marriage good- oops, my intern gave me a beej. Gay bad- oops, I hired a male prostitute. The thing is, the laws and politics that they initially created are still there. We’re still debating gay rights because of homophobic folks who later are involved in gay sex scandals. We still think marriage is between one man and one woman, when the people telling us this can’t make that work in their own lives, and are involved in extra-marital affairs. So we forget about the scandals, and keep trying to make something work when the something is just a meme, an idea based on nothing. One of the hot topics this season? Gay marriage! Great! another step towards equality and freedom, yes, and a whole other segment of the population that will feel pressure to conform, and a whole other group of people to feel bad about themselves when they realize they can’t/don’t want to.

If you’re not inclined to be monogamous, don’t be. Make your own way. It might not be helpful for you to choose a political party to represent you that doesn’t accept your relationship choices, but ultimately, having freely chosen your relationship style, one of many relationship styles on the planet (read the book “Sex At Dawn by Ryan and Jetha), you’ll fare much better psychologically and emotionally in the long run. A relationship built on honesty, working through difficult conversations, mutual trust, respect, empathy, and unconditional acceptance sounds much more appealing and healthy than accepting the seemingly unnatural (if you read any research on sexual fidelity whatsoever) hetero-normative, government-sponsored (reread above about government sex scandals) marriages.

Regardless of my license title, my whole style of therapy is summed up in the statement “Be who you are”. There is a lot of pressure to be what other people want you to be - “straight-acting”, sexually faithful to one person, married, in a monogamous relationship, rich, famous, educated, a homeowner, materialistic, religious, a parent, etc. The secret here is this is also the list of things people are struggling against when they come to therapy. When you realize that these states of being are not necessarily innate, that they are socially constructed and forced upon you, that is where you start to have some choice. Do you really want these things, or are you telling yourself that you absolutely have to have/be these things? This is where you start to have some freedom. That is where much of the depression, anxiety, paranoia, anger, (all normal feelings for humans) start to subside, and you’re on the right track to Be Who You Are.

Dr. Michael DeMarco is a therapist (licensed mental health counselor, licensed marriage and family therapist, and board certified clinical sexologist) and clinical supervisor in private practice in the hotbed of sex scandals, New York City. For more information, and other articles by Dr. DeMarco, visit http://www.mytherapistnewyork.info and/or http://www.mytherapist.info or follow him on http://youtube.com/mytherapistnewyork and http://www.twitter.com/drdemarco

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