How long does therapy take? Back
- What insurance companies may tell you
- Short term therapy
- Moderate term therapy
- Long term therapy
- Therapy in the age of managed care
- State regulations regarding mental health benefits
Insurance companies and managed care companies usually suggest that clients contract for a specific & limited number of sessions. They offer clients guidelines & suggest they ask the therapist what specific steps they are taking to solve their problems, but therapy does not often work that way. Therapy, at it's core, deals with feelings. It is about people and what is happening to them.
People often come to therapy because what has happened to them in the past affects their ability to handle what is happening to them today. Sometimes their past history didn't prepare them to handle their current challenges. In some therapies, the therapist doesn't see a mood disorder or thought problems, but simply a lack of information about how to handle some of life's challenges. In those situations, short term therapy offers a brief solution. Brief may be anywhere from 2 sessions to 6 months of sessions.
Short term therapy is appropriate for loss from death, loss of job, or home, such as in a weather disaster. Or for trauma such as being a crime victim, reaction to a severe car accident or loss of physical abilities as a result of illness or accident. The anxiety of relocation or a brief depressive reaction to disappointment may be amenable to short term therapies. Short term therapy is inadequate for a history of sexual abuse, chronic biochemical mood disorders, and complex family problems.
Moderate term therapy, for 6 months to 2 years, is useful for divorce and other family issues, for adjustment to life-stage changes such as depression that accompanies menopause, "empty-nest" syndrome, post partum reactions, adolescent rebellion or pre-marital therapy, for example.
Long term therapy, 2 years and longer, is an appropriate way to unravel depression and unproductive thinking that comes from a difficult childhood, entrenched anxiety and the results of abuse or severe trauma. A good question to ask yourself is "How long did it take me to get this way?" 30 years of problematic thinking cannot be expected to be fixed in 10 sessions.
As therapists, in the age of managed care, we are often put in the position of explaining why it takes more than 12 sessions to undo years of learned behavior and ways of thinking. Some of the expectations of insurors would be comical if the clients' situations weren't so serious. One insurance company's representative is said to have responded to a request for more than 10 sessions of therapy with this statement: "Well, was your client abused by more than one person?" "Yes", was the answer. "Okay then" she said, "I'll allow two sessions for each person who abused your client". Often, with insurors and managed care companies, we are dealing with people who have never done long term therapy or had therapy themselves. They are focused on reducing their payments to providers.
Don't be bullied by your insurance company. Notify your company benefits coordinator and/or your therapist if you need help getting your benefits. Check the mandated mental health coverage laws for your state. Call your state insurance commission and get information about how to get the benefits that insurors have promised the residents of your state.
Therapy is not a quick cure and should not be applied like a band-aid. It won't stick and you will not feel well cared for. The length of time it takes for you to complete a therapy, gain insight into your behaviors, and develop skills to handle life better has nothing to do with the amount of sessions your insuror thinks you should have. They are in the financial business. Therapists are in the treatment business. Insist on an appropriate length of sessions with the therapist of your choosing. In most states, insurance companies are mandated to provide about 50 sessions per year for psychotherapy (mental health treatment).
Some insurance companies will even intimidate you by having you interviewed by someone who is supposed to evaluate your needs before they will "authorize" your benefits. You should not have to explain your personal situation to anyone other than the therapist you will be seeing on an ongoing basis. Examine your policy closely to be sure you do not have to be screened in order to use your mental health benefits. If you do, switch to a better policy. Be aware that many employers only allow you to swtich during "open season" times. Usually, this occurs twice a year, during December and June for most companies.
Insurance companies are using the caveat "medically necessary" to designate what therapy they will take responsibility for. "Medically necessary" refers to how much the therapy is needed to prevent the client from harming themselves or someone else, or to alleviate physical symptoms associated with the emotional stress that the person is feeling.
What should you do if your insurance does not cover psychotherapy and your state does not mandate it. See "Financing your therapy".
