Center for Transition and Transformation

Penny Field, MA, LPC, NCC

Helping you grow through times of challenge and change

Psychotherapy & Insurance

Although certain mental health issues are indeed chemical in nature and recovery may be aided by the use of psychotropic drugs, most clients who seek psychotherapy from this practice do not fall into this category. Most often, the clients I see are seeking help in working through personal or family issues, transitional periods in their lives, or are feeling anxious or depressed and wanting help figuring out what's going on and how they might feel better. It is my desire to serve my clients in the best possible way by creating a relationship of trust and mutual understanding as we work through some very personal and private issues. Accepting payment from your insurance runs counter to that end and can, in fact, be damaging to you in a number of ways you may not be aware of.

• DIAGNOSIS: Insurance companies require that therapists diagnose their clients with a mental disorder from the Diagnostic and Statistical Manual for Mental Health Disorders (DSM IV). In other words, whether you are seeking help for career issues, family issues, personal issues, or any other reason, in order for your insurance to pay, you must be diagnosed with a mental disorder. This diagnosis becomes part of your permanent medical record. The less serious the disorder, usually the fewer sessions the insurance will pay for, creating a situation where therapists have incentive to give a more serious diagnosis then may be warranted.
• CONFIDENTIALITY: If insurance is paying for sessions, the most binding contract is between the therapist and the insurance company, NOT the therapist and the client. Insurance companies require the therapist to report what goes on in the sessions and can demand the therapist divulge very personal material of the client's in order to cover the session. Therapists must keep detailed records and send copies to the insurance company any time they are requested. This information, along with the diagnosis, becomes part of the client's permanent medical record and can effect their ability to obtain insurance at reasonable prices at a later time. It is also likely that at some time in the future, these records may become available to employers as well as other insurance companies and medical establishments.
• CONFLICT OF INTEREST: Because therapists have a binding contract with the insurance company to share details about the client's lives and to diagnose in order to receive payment, there is a clear conflict of interest on the part of the therapist. People need real privacy in order to speak openly to receive the help they are seeking. Most often, what clients share in therapy is about their low self-esteem, unfulfilling relationships or unmet expectations for themselves and others. It is about their friends and associates, their parents and children and partners. If therapists must label these issues as a "mental disorder" in order to receive payment, and pass on the details of their client's lives to the insurance company, who is really being served?

I believe that the client's needs are first and foremost and therapy is for you and a service that you are choosing to purchase to help you through times of transition or challenge. Because I hope to create a relationship of deep trust where you feel safe to share whatever you need to, I do not accept insurance payments. I will be happy to work with you to determine the cost of our sessions based on a sliding scale fee.