The Therapy Investment

Rates and Insurance

Rates: The fee for service is $250 for a 50 minute session. A double session is 90 minutes and the fee is $450. If you prefer longer or shorter units of time, we can arrange for different session lengths with the fees adjusted accordingly.

It is best to pay at the front desk when you arrive for your session as we may discuss challenging material and you may be more comfortable leaving directly when the session is over. Payment can be made with cash, AMEX/Discover/VISA/MC or a personal check.

Insurance: If you have insurance coverage, we will be glad to provide you with a receipt or statement satisfactory for filing an insurance claim at the end of each month. My office will be glad to assist you in learning how to determine the extent and limitations of your coverage. Therapy is a significant personal and financial commitment. Please do not hesitate to discuss financial matters with me.

If you have difficulty paying for therapy as outlined here, then you and I can discuss an alternative plan. If payment is neglected, I reserve the right to stop therapy until the balance is met. I would of course discuss such a termination in detail with you before it went into effect. If it is necessary to use collection procedures interest will be charged at the rate of 1 1/2% per month (18% annually) beginning 30 days after the charge is incurred.

Investing in Yourself

Engaging in psychotherapy demands a lot of both of us. It is a financial commitment, a time commitment, and most of all a commitment to work together.

In my view, entering therapy is like making an investment in yourself. By dedicating yourself to the process, you will probably feel better and improve your ability to deal with the specific issues that brought you to therapy. You’re also likely to gain skills and resilience that you can draw upon when facing other challenges in your life now and in the future.

As one client said, I am not sure exactly when it happened but I am just so much happier with myself. Some people think of it as an investment in yourself, as you might invest in new furniture for your home or a new car. When it works well, it costs less and lasts longer.

Legal Matters: Some situations involve legal matters. If you are involved in a legal situation of any kind, you are expected to sign the retainer agreement at the beginning of therapy. This is for your protection and mine. See retainer agreement under forms if this applies to you.

Report Fees: Fees for report preparation includes a review of records and will be billable at $250 per hour and not included in testimony charges. Additional guidelines are detailed in our Therapy Policies and Procedures and in the retainer agreement

MISSED APPOINTMENTS AND CANCELLATIONS: Sometimes emergencies come up. If I need to cancel or change an appointment time, I will give you at least 24 hours’ notice, as I know you will have reserved the time for the appointment. If for any reason I cannot give you 24 hours’ notice, I will provide our next 45 minute session free of charge to you. Likewise, I expect that you will give me 24 hours’ notice if you must cancel any appointment. If, for any reason, you cannot let me know 24 hours in advance you will be charged the regular fee for the time reserved.

Effectiveness of Psychotherapy

Dr Martin Seligman, past APA president and respected researcher, author and therapist summarized a major study of psychotherapy, which he described as ‘the most extensive study of psychotherapy effectiveness on record” as follows,” Consumer Reports (1995, November) published an article concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy…. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. Further studies have compared psychotherapy and medication.

Although as a therapist I follow the guidelines of the APA that medication should be prescribed after 2 weeks in certain situations, more studies are finding that psychotherapy is a clinically–and economically–viable alternative to medication.

Emerging research

Over the long run psychotherapy is often more effective, and thus cheaper, for many conditions. Although psychotherapy requires more of an upfront investment it pays off by getting the job done and preventing relapses. By contrast, patients on medication often relapse once their medication stops and may require a lifetime of expensive pills. In a column in Drug Benefit Trends, Psychiatrist Jay M. Pomerantz, MD cites several studies from the ever-increasing literature on this topic to prove his point:

In a randomized, controlled trial, researchers assigned 75 outpatients with recurrent major depression to three groups: acute and maintenance treatment with antidepressants, acute and maintenance cognitive therapy and acute antidepressants followed by maintenance cognitive therapy. Cognitive therapy proved as effective as medication in both the acute and maintenance phases, with a trend favoring cognitive therapy’s long-term efficacy (British Journal of Psychiatry, 1997, Vol. 171, p. 328-334).

In another study, researchers randomly assigned 40 patients who had been successfully treated with medication for recurrent major depression to two groups: clinical management or cognitive-behavioral therapy. Over 20 weeks, antidepressants were tapered off and then discontinued in both groups. Two years later, only 25 percent of the patients who received cognitive-behavioral therapy had relapsed compared with 80 percent of the other group [Archives of General Psychiatry, 1998, Vol. 55(9), p. 816-820].

In a meta-analysis of studies published between 1974 and 1994, researchers compared controlled trials of cognitive-behavioral therapy and pharmacological treatment for patients with panic disorder. While both treatments worked in the short run, the results were more positive and longer lasting for cognitive-behavioral therapy (Clinical Psychology Review, 1995, Vol. 15, p. 819-844).

There are plenty of other studies with similar results, says psychologist Steven D. Hollon, PhD, of Vanderbilt University, citing the work of psychologists like David H. Barlow, PhD, on panic disorders and G. Terence Wilson, PhD, on bulimia. Hollon’s own research on depression has also found that people who receive focused psychotherapy stay better longer than people who just receive medication.

If the insurance industry would only listen to this research, says Hollon, the implications could be far-reaching.

“Just do the math,” he says, noting that pharmacotherapists may keep depressed patients on expensive antidepressants for the rest of their lives. “If you can get with four months of psychotherapy the same benefits you get from a year and a half to two years of continuous medication, you begin to break even after about a year’s time even though it’s more expensive upfront to provide psychotherapy. If the benefits extend over a half decade or decade, your savings really start piling up. But managed-care folks don’t think that way.”

They also don’t consider the troublesome side effects that often accompany medication use, says David O. Antonuccio, PhD, a professor of psychiatry at the University of Nevada School of Medicine and staff psychologist at the Veterans Administration Medical Center in Reno. Who, he asks, can put a price on a patient’s inability to have sex as a result of taking an antidepressant?

In a cost-effectiveness analysis of cognitive-behavioral therapy, Prozac and combination therapy, Antonuccio took into account other, often overlooked factors such as lost productivity, wages, taxes and community service during treatment (Behavior Therapy, 1997, Vol. 28, p. 187-210). He concluded that providing Prozac alone would cost an estimated 33 percent more than cognitive-behavioral therapy over a two-year period and that providing combination therapy would cost an estimated 23 percent more.

For Antonuccio and other psychologists, however, the issue is less about costs and more about underlying philosophies.

“Consider the analogy of giving a hungry man food or teaching him how to fish,” he says. “Psychotherapy, particularly problem-focused, skill-oriented treatment, is a way of teaching people skills they can use to prevent, reduce and delay depression and other problems.”
I like this analogy and feel it applies in my practice.

Adapted from information in an article by Rebecca A. Clay APA Monitor
Volume 31, No. 1, January 2000

Choosing a Therapist

The decision to begin therapy marks the beginning of a significant investment in one’s quality of life and relationships. Finding the right therapist is a highly personal decision, and you’ll want to find someone who feels like a good match.
Many people are hesitant to ask a doctor questions about their background or experience. Remember you are the consumer and any competent professional should welcome questions or concerns regarding their expertise or the therapy process. Most therapists offer initial consultations for a set fee. Use this time as an opportunity to find out about the therapist, talk about your goals and reasons for pursuing therapy, and ask for their assessment of your situation and how they might help you. Through this process, you’ll decide whether this therapist is someone with whom you feel comfortable and confident.

Questions for a potential therapist or office manager.

• What is your education, training, and background?
• Are you licensed or certified by your professional board?
• What is your approach to therapy?
• How much of your caseload is treating my kind of problem?
• How long are appointments, how often should I see you, and how long does therapy generally take for my kind of problem?
• Are you available for emergency consultation if I experience a crisis?
• What are your policies regarding confidentiality (especially re: couples therapy, family therapy, and treatment of a minor)?
• What is your assessment of me and my situation?
• If you formulate a specific diagnosis, will you inform me?
• What are your views on (mention any specific issue, such as gender roles, marriage and divorce, religion, etc., that is important to you)?
• For couples and family therapy, in particular – Are you married? Do you have any children?
• Are there any potential risks to therapy?
• What advice do you give clients about getting the most from their therapy experience?
• What are your fees and financial policies (charges for telephone calls between sessions, cancellations, missed appointments)?
• Do you take insurance?

Evaluating a Potential Therapist:

• Training: In general, your therapist should have professional credentials including specialized training in the area of your problem.
• Experience: In order to work well with you, a therapist should be quite experienced with the type of problem you are trying to resolve.
• Connection and “Good Fit”: Research shows that the quality of the therapeutic relationship is a primary factor in making therapy successful. You should feel comfortable with the therapist you select and sense that he/she is competent and prepared to help you achieve your goals.
• Personal Boundaries: A good therapist should be warm and friendly and may share some relevant details about his own life, but he should never spend the session discussing his own personal issues.
• Response to Feedback: A good therapist gives straightforward answers to direct questions, welcomes client feedback and takes complaints seriously.
• Accurate Assessment: A good clinician should be able to give you an initial assessment that captures your problem or dilemma, sheds some interesting light on factors that may be contributing to the problem, and suggests important steps that will likely be necessary in resolving these problems and helping you achieve your goals.
• Clarity about Goals: A good therapist will discuss the specific goals for therapy with you.

What to look for in a Couples Therapist

Many people are unsure what to expect of a competent couples therapist. Here are some qualities and actions that researchers have found to promote effective marital therapy.

Do’s

• The therapist is caring and compassionate to both of you.
• The therapist actively tries to help your marriage and communicates realistic hope that you can solve your marital problems. This goes beyond just clarifying your problems.
• The therapist is active in structuring the session. The therapist has a plan to contain angry exchanges.
• The therapist offers reasonable and useful perspectives to help you understand the sources of your problems.
• The therapist encourages and challenges each of you to reflect on your contributions to the problems and helps you see to make individual changes that could improve your relationship and resolve the problems.
• The therapist offers specific strategies for changing your relationship, and coaches you on how to use them.
• The therapist is alert to individual matters such as depression, alcoholism, substance abuse and medical illness that might be influencing your marital problems.
• The therapist is alert to the problem of physical abuse and assesses in individual meetings whether there is danger to one of the spouses.

Don’ts

• The therapist does not take sides, judge, shame or blame.
• The therapist does not permit you and your spouse to interrupt each other, talk over each other, or speak for the other person.
• The therapist does not let you and your spouse engage in repeated angry exchanges during the session.
• Although the therapist may explore how your family-of-origin backgrounds influence your problems, the focus is on how to deal with your current marital problems rather than just on insight into how you developed these problems.
• The therapist does not assume that there are certain ways that men and women should behave according to their gender in marriage.

Adapted from William J. Doherty, Take Back Your Marriage: Sticking Together in a World That Pulls Us Apart. New York: Guilford Press, 2001 and Judith Anderson Ph.D

Financial Benifits of Therapy

When people have a need for therapy, they often gain so much financial benefit that therapy becomes a wise use of their time and money.

Many research studies show that therapy can reduce future medical expenses. Because so many long-term health care expenses are a result of stress or untreated mental health conditions, proper mental health treatment greatly lowers the overall cost of health care. In fact, this “medical cost offset” is so large that when medical costs are measured over a period of three to five years after treatment, psychotherapy lowers overall health care costs so much that it would more than pay for the cost of the therapy.

Therapy can also improve a person’s performance on the job. Employers are becoming increasingly aware that mental health problems can increase the number of sick days, interfere with the quality of an employee’s work, and decrease an employee’s productivity. The financial benefits of treatment are so great that many employers have hired employee assistance programs to provide short-term therapy and identify employees who can benefit from longer-term therapy.

Executives and some other people are now using a form of psychotherapy – coaching – to improve their effectiveness and performance. Moreover, psychotherapy helps many individuals succeed in gaining promotions or become ready to change to a better job.

Problems with relationships and family issues can be very expensive. There are enormous costs that can result from divorce, child adjustment problems, or other relationship problems. Individual and family therapy can go a long way in averting these costs.

So how should you decide if therapy is a wise use of your money? Of course, individuals are different and need to decide this for themselves by making some educated guesses. To figure this out for yourself, try to estimate the total cost of your therapy and compare it to the long-term benefits. You can ask your therapist to help by estimating how long it might take to accomplish the kind of changes that you hope to make in therapy. Use this information to estimate the cost of therapy.

To estimate the financial benefits, consider the changes that you are making in stress levels that may affect your long-term health care costs. Look at whether the therapy is helping you be a more productive employee or enabling you to earn more money through promotions or by changing jobs. Look at the relationship and family problems that you are working on in therapy and evaluate if the therapy is likely to avert expensive problems in the future.

When you estimate the cost/benefit ratio, remember your personal improvements may yield financial benefits over many years to come, and the therapy costs are usually spent up front. If you are like most people, as long as there is a need for treatment, you will find that the potential financial benefits probably justify the investment in psychotherapy even when insurance does not pay for the treatment. In addition, think about the possible intangible improvements in your quality of life that cannot be measured financially.

Ivan J. Miller is Co-Chair of the Interdivisional (39/42) Task Force on Managed Care and Health Care Policy, which believes that promoting psychology calls for more public education about the benefits of psychological services. This article was previously published in the APA Divion 42 Independent Practitioner Fall 2005.