The news has been scary for folks identifying as transgender, gender non-confirming, or non-binary. While there are often social forces trying to erase trans* identity, there is a concerted effort in the United States government (which is where I practice counseling) to do just that. I don’t have easy words.
If you are trans* identified or in the process of understanding your own gender identity, I see you and honor you. You are not a burden. You are vibrant, amazing, and so loved. Take care of yourself. If you’re in Maryland and looking for trans-affirming support, I’d be honored to work with you.
Cisgender allies (those who do not identify as trans*) – let’s lift up the voices of our trans* siblings, knowing they don’t need to be saved. Listen to and amplify voices – give the support that’s needed in the ways it is asked for.
We’re in this together. Let’s fight the monsters trying to silence and erase human beings, together.
The Trevor Project is an LGBTQ+ affirming 24/7 crisis hotline. 1-866-488-7386 Chat and texting available at certain times of the day, 7 days a week.
One of the things I mentioned briefly in the Therapy 101 series was if more than one session a week is needed. That deserves a bit more description and attention.
When we think about counseling, there’s one of two things most people seem to consider: either a weekly appointment or going every single day (like you’re laying on a couch and free associating). Those are pieces of what could be possible. Part of it is based on something called levels of care.
Levels of care are just that – different levels of support or care of treatment that you can receive. In today’s post, we’ll talk about most restrictive to least (by restrictive, I mean how much support you’re getting, usually determined by number of hours you’re receiving care of different kinds). Depending on what’s going on, someone can move up in levels of care (more support) or down (less support).
These levels of care are determined by what you’re experiencing, what levels of care you’ve already done, and circumstances. What’s below is general information; check with your counselor or health care professional for more information. (I can’t answer questions about someone I don’t know, as an FYI.)
Hospitalization/inpatient – This level of care of often through hospitals and is a 24/7 level of care, usually including medical and therapeutic. This level of care requires someone to stay in the treatment location for a period of time (this varies based on need). This is a good option if someone is in imminent danger for harming themselves (or someone else), because there is always someone around (medical personnel, therapeutic). In this level of care, there are often group and individual treatment opportunities.
Residential – This level of care is supported living and can mean that there is staff available 24/7 all the way down to multiple visits by support staff multiple times per week. It depends on the location, services, needs of the client. The person lives in a residence owned by an agency/company from whom they are receiving services. (This may vary by provider.)
Partial Hospitalization Program (PHP) – PHP programs are often a step-down from hospitalization or inpatient services. This means that they’re a good option after a 24/7 option because they are often 6-8 hours a day, up to five or six days a week. They provide a lot of support but not living at the program. There’s a combination of group and individual work in PHP.
Intensive Outpatient (IOP) – IOP is another good step down option after inpatient or PHP (some programs have IOP meet during parts of the PHP, if the location has both services). IOP is generally about 3 hours a day, generally between 9 and 12 hours a week. Again, you aren’t living on site, but you still have a lot of support. There is a combination of individual and group treatment.
Outpatient – This is the level of care I provide here at An Intentional Pause. Outpatient is traditionally one hour a week; sometimes, if needed for a short time, a therapist and client may choose to work with one another for longer sessions or multiple times a week, no more than 9 hours a week (at that point, someone would be referred to IOP). There are times I’ve worked with people I’ve recommended both group work (usually an hour to 90 minutes a week) and one individual session (one hour). It definitely depended on what was going on, needed support, as well as other factors discussed with my client.
Brief note: Groups are often scary to think about as a client. I used to run a number of groups at previous agencies I worked for, and I was always amazed at how people learned from one another and grew as individuals in group work.
Aftercare – Some clients aren’t quite ready to stop counseling; many places and therapists have the option for aftercare, which are check-ins at a pre-determined length of time between sessions. That length of time is dependent on policies for the provider, insurance requirements, etc. It would be something to discuss with the provider, as there may be additional (non-therapy) supports to build into your after care plan!
Note: All of this is general information. Your best bet is always to call your own insurance carrier to verify benefits and get providers they have on file who take your insurance.
One of the things that you may be wondering about AIPC (and counseling in general) is if you can use your health insurance benefits. Oftentimes, YES! There is supposed to be parity in insurance, meaning that mental health coverage should be just as present as physical health benefits. Super cool, yes? Especially because we often pay so much for health insurance; we want to be able to use it!
I totally get it; being able to get therapy covered may be a HUGE benefit and support in getting you in the door. It can lessen the stress that may come about finances when thinking about paying out of pocket for services.
A few things you should know before using your insurance:
You may have a co-pay. As a provider, I can’t change or reduce this, given my contract with your insurance company. You can contact your insurance company to find out what it would be.
Your insurance may only cover a certain amount of sessions. Again, this is specific to your plan, but you should be aware this could be the case.
If you’re using your insurance, I will have to use a diagnosis and release that diagnosis to your insurance company. That said, if what brings you into counseling does not meet criteria, we’ll have that conversation. (I could still see you, you just wouldn’t be able to use your insurance. At that time, we can talk about a sliding scale – a reduced fee if necessary.)
I may also have to release treatment information to your insurance company, if required. This may include notes or treatment plans.
Diagnoses and treatment information is then included in your medical history beyond my office. This may be a positive or a negative; it could also have later implications in careers, such as if you are seeking clearance, say for a government job.
Therapists are split on taking insurance, for a lot of reasons. I’ve chosen to get paneled with some insurances because it opens private practice options to individuals who may not otherwise seek treatment. Plus, the theories of counseling I most frequently use often align with evidenced based practices required by insurance panels (cognitive behavioral, strength-based, and solution-focused therapies, as well as motivational interviewing).
I’m super excited to share that I am (finally) hearing back from insurance providers and (as of October 7, 2018), am currently a provider with: United Healthcare, GEHA, Cigna, Aetna, and Maryland Medicaid. I’m waiting to hear back and finalize the process with a few other insurances. I’ll update the Services and Fees page when that happens.
(Looking to use insurance that I’m not currently able to accept? Contact me to see if yours is on the list. If it’s not? Let’s talk sliding scale. You never know unless you ask, right?)
Other questions about using your insurance? Contact me and let me know!
I think one of the hardest balances to strike within counseling is the one between comfort and discomfort. On the one hand, I want you to feel safe – that you’re able to share the things that you need to in the counseling process. This may take some time (and that’s okay!) but should be part of the overall experience of counseling.
But, my job is not necessarily to make you comfortable all the time because change is hard. Change is anything but comfortable at times. And yet, the discomfort of whatever brought you into counseling is what we’re trying to change, right
It’s something to consider as you look for a counselor. What do you need to find that kind of balance? To find the courage to get uncomfortable with new behaviors, thoughts, feelings because the ones you’re used to aren’t working anymore?
It’s about finding the ways to practice your new skills – including taking care of yourself when things are hard! – so what we’re working on becomes a “new normal.” New habits. New behaviors. New thoughts. New feelings.
So we come to the end (ish) of the Therapy 101 series. We’ve gone through before and during therapy – but, as I’ve said, I don’t see therapy as being an ongoing for-the-rest-of-your-life thing. Rather, I see counseling as something we may go into and out of throughout our life when things become difficult and we may need some extra support.
So, how do you know when it’s time? Well, there are a few markers that begin to pop up:
Sessions begin to be more chit-chatty.
When we are talking less about what brought you in and talking more about other things, this may be a sign that our time together is drawing to a close.
You have fewer things to talk about in session.
Similar to the above, you may come into session and not have anything to say. There is nothing pressing, you’re doing well using your skills, and we will celebrate that and also talk about what you may need to keep on keepin’ on.
You’ve met your goals we talked about in the beginning and there aren’t any others you can think of.
Early on, we talked about goals you had for our time together. Maybe other goals have popped up, but maybe you’ve gotten what you needed from this round of counseling in your life, with no other concerns.
We agree upon finishing our work together.
Maybe you’ve considered that our work together is at a close. If, after discussion, you would like to end services (for whatever reason), I will help you find other resources as necessary. Please don’t just stop coming; I’d love to connect you with others who may better serve your needs as necessary.
Now, it won’t just be, “Alright, all done.” We’ll begin cutting down on the number of sessions – maybe from weekly to biweekly, biweekly to monthly. If, after moving to monthly sessions, some of the same is still occurring, we’ll begin reviewing what you learned and the support you will need to keep on the path of your new behaviors and skills.
(And, know that you are always welcome to come back if necessary.)
Ready to start the journey toward finding pause? Making different decisions? Learning skills to help you get through the tough stuff? Drop me a line or schedule a free consultation. I’d love to hear from you.