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Dr. Bob is Robert Hsiung, MD,
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Posted by Waterlily on May 13, 2001, at 21:02:09
I'm new to the board, but not to mental illness. My dad was an alcoholic who committed suicide when I was 14 years old. I'm now 32 years old, happily married 12 years, and a mother to two daughters. I suffered postpartum depression after the birth of my 6 year old. I got treatment with medication (Zoloft and later Wellbutrin) and was in remission with medication for a good 5 years. I was told by three psychiatrists that there was no need for therapy. I'm on my third because the first retired and the second took a fellowship in pediatric psychiatry. Anyway...last summer I suffered my first panic attacks and was put on Paxil and Ativan. I went off Paxil after only a few months but had no troubles and didn't take Ativan very often, until after September, when I had a tubal ligation. Now I'm on imipramine in addition to my Wellbutrin and take Ativan only on rare occasions. I asked my psychiatrist to refer me for some therapy. I've been going weekly or bi-weekly for about two months. Here's my questions:
1) My insurance will foot the bill for 20 sessions, minus my $25 copay. What do you guys do about footing the rest of the money? Not go to more than insurance will pay for? Or do you bite the bullet and pay the $110 per hour?
2) How long does therapy usually last and how often do you see your therapist?
3) I'm afraid of becoming too dependant on my therapist. I don't want to form an emotional attachment because I will not be spending years with her. I'm having trouble opening up to her without an emotional attachment and I do not want to look at her as a parent figure, although I would feel tons less nervous if I did. How do you deal with this issue?
Posted by mist on May 13, 2001, at 23:56:21
In reply to New here - questions about therapy, posted by Waterlily on May 13, 2001, at 21:02:09
I've never formed an emotional attachment with a therapist. I don't know why. I don't know if most people do or not. For me, it's kind of hard to think of the relationship as a personally meaningful one. They're just someone I pay for a service.
I also don't understand how they can justify charging so much on a weekly basis, especially since therapy sometimes lasts 1-3 years or more. (And $110 is low for some, amazingly enough.)
> I'm new to the board, but not to mental illness. My dad was an alcoholic who committed suicide when I was 14 years old. I'm now 32 years old, happily married 12 years, and a mother to two daughters. I suffered postpartum depression after the birth of my 6 year old. I got treatment with medication (Zoloft and later Wellbutrin) and was in remission with medication for a good 5 years. I was told by three psychiatrists that there was no need for therapy. I'm on my third because the first retired and the second took a fellowship in pediatric psychiatry. Anyway...last summer I suffered my first panic attacks and was put on Paxil and Ativan. I went off Paxil after only a few months but had no troubles and didn't take Ativan very often, until after September, when I had a tubal ligation. Now I'm on imipramine in addition to my Wellbutrin and take Ativan only on rare occasions. I asked my psychiatrist to refer me for some therapy. I've been going weekly or bi-weekly for about two months. Here's my questions:
> 1) My insurance will foot the bill for 20 sessions, minus my $25 copay. What do you guys do about footing the rest of the money? Not go to more than insurance will pay for? Or do you bite the bullet and pay the $110 per hour?
> 2) How long does therapy usually last and how often do you see your therapist?
> 3) I'm afraid of becoming too dependant on my therapist. I don't want to form an emotional attachment because I will not be spending years with her. I'm having trouble opening up to her without an emotional attachment and I do not want to look at her as a parent figure, although I would feel tons less nervous if I did. How do you deal with this issue?
Posted by shelliR on May 14, 2001, at 10:26:31
In reply to New here - questions about therapy, posted by Waterlily on May 13, 2001, at 21:02:09
> 1) My insurance will foot the bill for 20 sessions, minus my $25 copay. What do you guys do about footing the rest of the money? Not go to more than insurance will pay for? Or do you bite the bullet and pay the $110 per hour?
> 2) How long does therapy usually last and how often do you see your therapist?
> 3) I'm afraid of becoming too dependant on my therapist. I don't want to form an emotional attachment because I will not be spending years with her. I'm having trouble opening up to her without an emotional attachment and I do not want to look at her as a parent figure, although I would feel tons less nervous if I did. How do you deal with this issue?Wow, Waterlily, you are asking some very tough questions. Considering you have 20 sessions (per year, right?), I think you have to figure out what exactly you want from therapy. Obviously, twenty sessions is not enough time to do long term intensive therapy. But is that what you really need? Or can something else substitute?
With panic, there is the option of shorter term cognitive therapy, especially since you have the ego strength to participate in a successful marriage. Using therapy to work specifically on those areas that trigger panic.
There are also groups which are specific around working with children of alcoholic parents--not 12 step groups, but groups that use a workbook and go through your history and how it affects you now. I was in one years ago for children of dysfunctional families and we used the book I mentioned above, although we all did not have alchoholic parents. Groups are definitely a lot less expensive.
Another possibility is doing the intense, long term therapy with a less expensive therapist. Normally I wouldn't recommend a counselar over a psychologist, but if you live in a city with lots of choices, you will probably be able to find someone who is excellent to work with. As an adjunct to my therapy (which is covered 50% for any amount of sessions and I have a co-pay insurance), I went to a woman who is licensed in counseling who also does body work. Since most of my depression is in my chest, I thought it might be a good way to excelerate my therapy. She only charged $70 an hour and I thought she was wonderful. I felt she had at least as much understanding as the psychiatrists and psychologists I have gone to, but since my insurance covers my psychologist and I think she is excellent, I remained with her as my primary therapist.
I think long term intense work does require an attachment, so I think if you are going to do that kind of work, you either (as you said) have to bite the bullet, or find someone who is less expensive.
Shelli
Posted by Waterlily on May 14, 2001, at 12:00:01
In reply to Re: New here - questions about therapy, posted by shelliR on May 14, 2001, at 10:26:31
Shelli - When you asked what I want from therapy, I am not really sure. My therapist asked me that in my first session, and my answer was basically to get me back to where I was before the panic attacks. I want to stop worrying about what I'm feeling. However, where I was before is not exactly the best place to be either. My husband claims that I'm not the same as I was when we first married and that I'm no fun. For his sake, I'd like to satisfy that requirement as well. About a month into therapy I had a few bouts of depression and anxiety. I expressed my frustration with the setback with my therapist and she said "Give me more time. I've only just started working on you." This statement leads me to believe that she thinks it will take a long time to get me to where I want to go. My husband said that money should not determine whether or not I continue therapy. He thinks that my happiness is worth whatever it takes. I can see that the therapy thus far has helped, so I'd like to continue with the psychologist I have now.
What is bodywork? Is that something like biofeedback? Does progressive muscle relaxation do basically the same thing? I never really thought of depression as stemming from some place in the body.
Posted by Ted on May 14, 2001, at 14:03:57
In reply to Re: New here ....To Shelli, posted by Waterlily on May 14, 2001, at 12:00:01
Waterlily,
Wow! You sound like you have a great husband! I too am just starting therapy, and I also don't know what I want or what to expect. Your insurance is almost the same as mine: in-network is 20 visits with $10 copay, out-of-net is 50% for 20 visits per year. Precertification is required, so if I just go, then I get no coverage; I have to call ahead and make all arrangements with my insurance provider first. As it turns out, the therapist I chose and like is only an intern and not yet licensed, so I get *NO* coverage at all -- it's all out of pocket. Despite going rates of around $90-$130 per 50-minute session, mine only charges $80/session.
Ted
> My husband said that money should not determine whether or not I continue therapy. He thinks that my happiness is worth whatever it takes. I can see that the therapy thus far has helped, so I'd like to continue with the psychologist I have now.
Posted by shelliR on May 14, 2001, at 19:12:38
In reply to New here - questions about therapy, posted by Waterlily on May 13, 2001, at 21:02:09
Waterlily, I wrote you back a response, but somehow it disappeared. If it doesn't show up, I'll try to write again later or tomorrow. Sorry, I did try to answer you, but it says my name if you hit reload, then it says msgs/6000.html was not found on this server. Shelli
Posted by shelliR on May 15, 2001, at 12:29:06
In reply to Re: New here ....To Shelli, posted by Waterlily on May 14, 2001, at 12:00:01
> What is bodywork? Is that something like biofeedback? Does progressive muscle relaxation do basically the same thing? I never really thought of depression as stemming from some place in the body.Hi Waterlily. Hopefully this post won't go floating out into space, but I'll copy it just in case.
I feel my depression totally in my body--mostly right in my chest. My assumption is that as a child during really awful times I would hold my breath and the repetition of this created a horrible tightness there. With body therapy, we talk first about what I am feeling, then she does some message mostly on my chest to open it up. Lately, since I have such a disconnect between my thoughts and feelings, she had been working on making that connection by working both on my head and chest. Before I leave we talk again-- about what has come up for me. Feelings come up for me that are blocked in talking therapy, so it has been a good combination therapy for me.
However, for financial reasons, I am taking a break from it--I pay so much for insurance and co-payment insurance that I have little else to spend on alternative therapies. I own a small business and it's set up as a c corporation so I can deduct all medical expenses, but still I can't spend more than I earn!
It really seems like you really know your answer about therapy. You can afford it, your husband is being really supportive about it, and you feel like your current therapist is helping you. Go for it!
I do think that one should always have specific articulated goals in therapy. (My current therapist is a major advocate of that). It seems to keep me from going in circles. We set both short term goals and long term goals (with no time frame on the long term goals.) I think it really helps me to really use therapy for change, rather than just having someone to listen to me. So I think in the long run, even in long term intensive therapy it may cut the total time down. (IMHO)
Shelli
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