Will my health insurance pay for counseling?

Although most providers require you to take ultimate responsibility for paying your bill, health insurance may reimburse you or your healthcare provider for medically necessary treatment for covered, diagnosed conditions that impair your ability to function. They do not generally pay for counseling to relieve stress, enhance or maintain wellbeing or prevent problems down the road.

The exception to this rule is that some employers provide employee assistance programs which offer limited counseling for short term problems or crisis. Often these programs are limited to three sessions and then they refer you on to another provider for further treatment, which, if it is medically necessary may be covered by insurance.

That means you must

• Be diagnosed with a condition that meets the standard diagnostic criteria (these conditions are described in detail in a manual: (DSMIV).
• Be unable to function normally without treatment.
• Receive treatment intended to relieve that condition.

Finally, you must be willing to release that information about yourself to your insurance company and willing to have that information in your permanent medical record.

Whoa…What about confidentiality?

You should have complete confidentiality (assuming you don’t present a threat to yourself or others) if you are paying for your own care. If you ask your insurer to pick up the tab, legally, they gain complete access to your record. Once you grant your therapist permission to contact them, you have given up confidentiality regarding them. Of course, insurers are also required to keep your records private (HIPAA). However, your information may end up being part of a database (MIB) that collects health records from insurance companies.

Practically speaking, the amount of information required by insurers varies considerably. Some only ever ask for a diagnosis and billing information. Others want a lot of specific personal information about your condition and the treatment plan, and expect to dictate the level of and length of care needed. Many experienced therapists avoid dealing with insurance companies like this. That’s why you may find the counselors your friends recommend may not take your insurance.

My problems aren’t a serious medical problem. Should I hold off on counseling until they are?

If that’s the case, it is often a very good idea to spend some money out of your own pocket to get counseling for stress, for relationship problems or to prevent more serious problems. Most healthy people find themselves depressed or anxious at some point. Getting help early can prevent a whole lot of suffering later, and it can help you avoid losing your ability to function at work or home. Short term counseling is no more expensive than, for instance, the 15,000 mile service to your car, a vacation or a new laptop.

I already have a therapist. Can my counseling there be covered by insurance?

You should check with your health insurance plan and with your therapist to see if your treatment can be covered by insurance. Not all plans cover mental health, although any company offering insurance in Chicago or in Illinois must also provide some coverage of mental illnesses.

I’m 25, we’ve just been married a year, and I’m happy but seriously disappointed by our sex life. It’s over too fast for me to climax. How do I tell my husband about this? I don’t want to break his heart, or his pride.

Ok, this is difficult, but everyone has to learn to do it. By “it” I mean talking about sex, not just doing it. It’s best to choose a relaxed, semi-quiet time, when having sex is not on the agenda. I think it’s great to ask for permission to bring up a delicate topic and create a playful, non-anxious attitude in your own heart at the same time.

It takes a long time, sometimes a lifetime, to get full “ownership” of our sexuality. And 25 is still young. Also, premature ejaculation can also be a problem for older men and their partners as well. What’s amazing is that couples can go for decades without resolving this issue. Accommodating this problem is only a temporary solution. Once it becomes a pattern it is self reinforcing and very demoralizing to everyone.

Credible lovers will not be satisfied unless they have also satisfied their partner as well. Therefore, your husband should be at least as interested as you are in a solution.

There are physical techniques that you can use to delay ejaculation; however creating a strong erotic connection during lovemaking is a more effective approach. Couples who can focus on and “track” the ebb and flow of their partner’s arousal during lovemaking are usually successful with their love life. This is a skill that is rarely mentioned or taught. But it makes sense, since tracking with other people’s moods, thoughts, and ideas is also critical to social competence. Eye to eye connection, playfulness and a true desire to please as well as be pleased builds this erotic connection.

And, when the connection is lost, don’t be afraid to stop, “retrace your steps”, go back and find it again.

If your statements about your sexual expectations are wrapped in desire rather than complaint or criticism, these conversations will more likely be experienced as delightful, seductive invitations.

If your husband is defensive, hurt or angry, you should suggest that you have the conversation at a latter time - at his initiation. Whether or not he initiates that conversation will tell you a whole lot about whether you need professional help.

Click for sample training materials:

Failures of Compassion

Building and Maintaining Care Teams for your Church

Creating Health and Caregiving Ministries

Couples therapy is increasingly important and relevant with the rates of divorce and separation climbing. For those who are struggling with relational problems or considering ending their relationship, couples therapy is a tool for managing conflict and making healthy choices. For those who are married, partnered, considering making a long term – and hopefully final- commitment couples therapy can be a great resource to building intimacy and resiliency for the challenges every couple and family face. Finding a therapist who respects the strengths of your connection and who will take a strengths-based approach is important.

In 26 years of clinical practice I’ve learned creating a strong, intimate connection in your marriage is the most important, most meaningful and most challenging work that you can do. Despite the challenges facing all couples these days, marriage is the primary tool available to you for personal development and maturity. (I use the word marriage in the most inclusive sense, honoring those who are not permitted to legally marry and their relationships.)

I encourage you to face opportunities for growth and maturity within your relationship because it provides the necessary “lab” for the “growing-up” each of us can accomplish as adults. In couples therapy I create an atmosphere of respect for your relationship and each individual. I ‘hold the tension’ between couples as I work with each partner to develop the skills to manage their own anxiety within the relationship and take responsibility to work on healing themselves.

For starters, I will help you develop your capacity to risk yourself within your relationship and your ability to successfully invite your partner to do the same. Compromise, “better communication” and negotiation will help you collaborate but won’t build joy, intimacy or marital satisfaction. Compromise creates an atmosphere of disappointment and frankly, negotiating away differences may extract excitement from the relationship, causing a loss of eroticism. There are exciting, playful and incredibly satisfying options to giving up or getting out! As a human race, we are now exploring new frontiers in intimacy; it is a great joy to participate personally and professionally, in this process of human growth and development.

If you ask marriage therapists about their most challenging cases, you will often hear that these couples sought help long after their first serious problems.

Marriage trouble is intensely personal. Few of us have seen our parents model the use of couples counseling. And, it’s hard to invest in a process where we become vulnerable, can’t predict how it will unfold and don’t have guaranteed outcomes.

What is predictable is that all marriages will have difficult times. Asking for help early is a predictor of success in couples counseling. Marriage is an incubator for grown-ups, since as newlyweds we never begin marriage fully mature. Making effective use of that incubator is made much easier with help from a compassionate, competent professional.

Sam was a brilliant businessman, intellect and romantic. He married Tia, a lovely aspiring singer, taking her to a beautiful, remote spot in a foreign land to propose. It literally mirrored a scene from a movie they saw together when they first met and fell in love. Marrying a beautiful, equally intelligent and charming woman who would make an attractive partner and who also held strong family values was about the best thing he could imagine happening to him. He was happy to support her aspirations to perform, however a few years into the marriage, when Tia began to find success, travel more and be emotionally consumed in challenging projects he felt cheated. (more…)