Well, I have to say that my state is well-known for its abundance of mental health practitioners and there are many excellent therapists and psychiatrists to choose from. I almost feel guilty about it, after reading your post, Merely Me! Last year, congress passed the mental health parity law which requires insurance companies to cover mental health the same way they do everything else, meaning no dollar caps or limited number of visits if that's how the rest of your health insurance works. It will be interesting to see how this plays out for the year.
My therapist, in the past, has had to request authorization for extra visits for the year and I've never been denied, partly because of how good she is at documentation. I've also got a psychiatrist who gives me a half hour per appointment - AND he does therapy, as well, although I don't see him for that, but he does want to know what's going on. He also involves me in decisions made about medication.
I think it would be a shame if talk therapy were to disappear. I do wonder if some of this haste to treat with only medication isn't part of our own doing, in terms of expecting a quick "cure" and not wanting to do the work that talk therapy requires. Some don't need much, others do, but when people say that talk therapy "doesn't work" for them, how much of that is because they've quit prematurely or didn't "click" with the therapist and didn't want to find another one? Don't get me wrong, I know there are plenty of incompetent professionals out there because I've seen and met them and it takes a lot of energy to keep looking for good ones, but the same can be said of any kind of doctor, really. It's just that in the area of mental health, it's very personal and the human connection is much more important than it is with the rest of the medical profession.
I know I'm very fortunate to have access to the quality of mental health care that I do and believe that everyone else should have it, as well.
Hey Judy
I am so glad that you have a good team to work with you. This simply is not the case for everyone and maybe some of this has to do with how each state delivers mental health services. I have to tell you that I am very envious.
When I was in my twenties I had a fantastic therapist and I just have not been able to find someone like him again. When you have a good therapist it makes all the difference in the world.
Thanks for sharing Judy. Your story does give me hope that things are not bad everywhere.
My history with psychiatrists was as described by the article: 5 minutes and a prescription. The mental health facility I initially went to was chosen because they took my insurance and could see me in a reasonable amount of time after I was diagnosed with depression. It was for medication management only - they offered no talk therapy. Soon it became a revolving door of doctors as their turnover rate increased. I changed to another facility but it was the same story.
Finally, at the suggestion of my psychotherapist I went to another psychiatrist. The initial in-take was over an hour and was very thorough. He diagnosed ADD on top of the depression, something that had been mentioned in passing by other therapists in the past but never pursued. Subsequent visits last at least half an hour, although they are not that frequent. He is always available for questions about side effects, symptoms, etc. I can't use my insurance with him so it's totally out-of-pocket but it's worth it.
On a side subject, I've had mixed results with talk therapists. The one I initially saw several years ago was wonderful- insightful, knowledgable, compassionate. After a break from therapy I went to another therapist of a specific speciality. She was extremely knowledgable, author of books and countless articles, etc., but I always got the sense that it was all about the business for her. She's a wonderful person but just never provided the help I needed. I eventually went back to my original therapist and still continue to see her and make progress. Again, it's out-of-pocket but I am fortunate that I can afford the expense and it is worth it. Many therapists choose not to be handcuffed by the restrictions insurance companies place on them so choose to not participate in programs. This is very unfortunate for a lot of people who otherwise cannot affort good mental health care. Really good mental health care, in my opinion, is, unfortunately, a luxury.
Hi there
I agree with you...it does seem that good quality mental health care is a luxury. And it shouldn't be this way.
It really is a toss of the dice as to which therapists are going to be a good match for you. But I do agree with you that a "spammy" doctor is not one I would respect very much. Yes it is a business but I would like to think that they honestly do want to help people and not just promote themselves and their books.
I am glad that you did end up with a therapist you like and who can help you.
Thanks for sharing your experience here.
Four years ago I walked away from a relation...THE relationship, it defined me in so many ways and the feelings went all the way into my bone marrow. I couldn't dig those out with a spoon- as much as I wanted to.
So...I talked to my Dr. who referred me to a therapist- and every other day for about 6 months at lunch time I would go to his office...And TALK. He listened, helped me work through some stuff and when the insurance ran out...he said I still had some work to do, so he gave me some tools to use and I was way better off at the end of the six months than in the beginning.
I think we have a responsibility to ourselves to find the right type of therapy that isn't just a pill pusher, or place where they move you in and out like cattle. They cost more, and insurance will only pay for a specific number of sessions, but it's worth it.
Talk therapy rocks...and when I can't TALK...I WRITE.
Hi there
I totally agree...talk therapy does rock! It can really help if you find the right therapist.
It does seem though, from the comments, that many of us have had to pay out of pocket for good quality care. Insurance doesn't seem to always cover the cost and that is for those who actually have insurance.
Thanks so much for sharing your story with us. Looking forward to hearing more from you.
I live in England, so I'm not sure of the specific differences in medical systems between the UK and the US, though I'm sure they are massively different....
Due to the NHS, I've experienced treatment both publicly funded and privately (ie my parents pay the £s). With the NHS, my Specialist would allow 40 minutes per session. However if I had an appointment at the end of the day this could end up being 10 minutes because of earlier appointments over-running. He was keen for me to go on medication, but I do feel that this was due to the severity of my condition together with my reluctance to open up.
I don't doubt that there is a large body of the population suffering from mild depression, and I think prescribing drugs for these people is disgusting. Depression at this level can be managed by teaching cognitive techniques in order to monitor negative thoughts and perceptions, or simply discussing issues and 'venting'.
However for those with moderate or severe depression, this alone is not enough. I found that CBT could not make me feel better quick enough. It was unable to give me the relief I desperately needed. I resisted medication because of the stigma around it and also because I was highly anxious and didn't like the idea of putting chemicals in an already mixed up body. However, if my Dr. had not persuaded me to begin this course of treatment, I can honestly say that I may not have been able to go on for much longer.
I am not qualified to say what people should do, neither spiritually or academically, but I think it's a shame to see people talk negatively about the side effects and dependence on drugs as a treatment option. I know that I spent hours online researching what people's experiences and opinions of drugs were, and I found a lot of people describing in detail horrific side effects and how they'd read that the initial 2 weeks of treatments could lead to an increase in suicidal thoughts in children and teens. Personally, I was terrified. It's stupid that I was so affected by this when I could have taken medication and improved sooner.
I don't think there will ever be a day where talk therapy will 'die'. It's human nature to need to talk about our experiences and worries, any idiot can see that! There is definately a delicate balance between biological and psychological treatments, and I can see how some systems are abusing this balance.
Hi Olivia
I am very fascinated by your story because I am curious as to how other countries handle their mental health care. It would be great if sometime you could talk about mental health care in England.
I hear you about the horror stories of side effects to medications. It makes you overly fearful to try anything. Medication can help in a lot of cases and I am glad it has helped you.
Thanks so much for participating in our discussion. Please do keep writing here...would love to hear more from you.
I have had a multitude of different "services" provided by therapist, psychiatrist and psycholgist. My first psychiatrist was also my therapist (1995) and I think he was too young and too inexperienced. He seemed frightened and affronted by my suicidal ideation and within a year decided to send me to a state hospital (which fortunately never happened.) My second psychiatrist was all "show" and little substance, meaning he had real Persian carpets and studded leather couches and the finest of decor, along with his $1000 suits. Within a year, he also decided I should be in a state hospital because he had "tried everything and nothing worked." Well, he tried very little beyond twirling his moustaches and glancing at the clock. Third time is a charm, I guess, because I have been with him since 1997. I chose a therapist right down the hall from him, and although they were not associates, they often worked together on my case and thoroughly discussed which direction to move in. If anything new came up and my therapist had a question, we would march down the hall to the psychiatrist and discuss it with him. On the spot. Almost as good as a house call. And he never charged for these mini-consultations. Sometimes she would call him on the phone between sessions and discuss how I was doing and how my medication was working. A real team effort! That's when I felt I was getting the best care. Now they have parted ways (moved to different parts of town.) Then my attempts at getting "good therapy" became disjointed and unproductive. So I think it is great if a psychiatrist and therapist can work in tandem...but they rarely do.
Right now, this same psychiatrist charges me $85 for a 5-min "medication review" and asks, "Are you having hallucinations or are you suicidal?" If I answer "no" to both, then I'm out the door with a prescription identical to the last one. If I have any question, such as discussing med side effects or my caregiver status, then he talks for maybe 12 minutes and charges $125 for a "complex diagnostic evaluation." What is the deal?
Wow Donna...
It is incredible how little talk time we have with our doctors. The doctor who would actually talk to you on the phone...and answered questions about side effects...that seems to be something very rare. I think I talked to you all about the experience I had with my son's neurologist where...there isn't even anyone at this big hospital to answer the phone...if my son had a bad side effect to his medication the only advice given was to go to an emergency room.
It seems that this is the trend for every service...pump up the volume...and who cares about quality? I have become very jaded over the years about our mental health care system. I don't know if we value mental health in this country.
Sorry for my vent. I just wish things were better...for all of us.
Thank you for sharing your experience with us...it is greatly appreciated.
Well I have to say what a well-put article. I started feeling angry even through all the medications coursing through my body! Many great points and ideas. I'm fascinated with Psychotherapy. I live in a small town, I'm a poor single mom with bipolar, chronic complex ptsd, psychosis, delusions, dissociative stuff, and adhd. So they say. I'm still deliberating over-diagnosis. That's another story. But in my small town, I was able to meet the most amazing Psychotherapist. She kept me with her for over ten years, and I had just started fading out from the therapy when the PTSD hit like a semi and took me out for a year. What I want to say is that the meds I received in my many trips to "the bin" saved my body, but the talk therapy I had received prior to it's full-blown peak saved my life. I was prepared mentally and spiritually to handle it. She knew it too, she didn't give me any crutches. It was a test of my will, and sharing that experience with someone (licensed to do so too!) is absolutely amazing to me. I wish you all could have what I had. It was Talk Therapy that brought from numb and empty and cracked and split to someone whole and spiritual. I'm sorry I know I'm ranting but a passionate piece deserves a passionate comment! Thanks so much, Merely Me!!
Amy
Hey Amy
Thanks...I am glad you liked my article.
I am so glad you found someone as wonderful as your therapist...I would be eager to hear what aspects of your therapy were most beneficial...and about the personal qualities of your therapist which made her such a great match for you.
I think you are right in that for so many people...talk therapy combined with medication is a very effective combination.
Looking forward to hearing more about how you cope with depression...I am sure you will be an inspiration to others facing similar challenges. Thanks so much for writing here.
I consider myself one of the very fortunate ones. My pmd wants on doing therapy while doing my meds so that he knows how things are going in my life. He sees me for 50 min. to an hour or so but is not a clock watcher. If something is being talked about towards the end I am the one that usually says something about time and he says it;s ok .We can finish this before we end. My cognitive therapist and he will consult with each other over different things and that is fine with me.
I see them both at least once a week and only have to pay a small co-pay. I know I am blessed. Now, if only that would take the depression away.
You reminded me of something or should I say somone--I live in a small town and there was only one psychiatrist with one nurse for a region of 8000-9000 people. They were overwhelmed. We're lucky and blessed too, my psychiatrist spent many weekends in the bin with me trying to figure me out. And his nurse, an amazing, amazing man, once sat on the phone with me in the middle of a busy week day as I sat at a gas station hypervigilent and panicking--Bill stayed on the phone with me for over 45 minutes until I calmed down. They are an amazing team.
Very interesting topic. As for Cognitive Therapy people don't understand that this method takes work, and its not the therapist, psychologist, or psychiatrist who will be doing it. It really is all up to the individual, and lets be open, many people simply want to go to the pharmacy, get a script that it makes it all better, and get back to living the same way that is CAUSING their symptoms.
When originally diagnosed with agoraphobia, all I wanted to do was resume my life. I went to my MD, who set me up with a psychiatrist, who after an hour prescribed some Ativan, and well, it worked. The only problem was that after a few months on the drug, as I tapered off, I had not learned any coping techniques, and soon was right back to the starting point.
I did see a Psuchologist for a few visits, and then felt better and stopped therapy. Unfortunately when a stressful event occurred, I was right back to my MD. who prescribed some anti-anxiety med. and well I felt better again. Move ahead to 2008, life was going well, at least I thought, graduated from the University, and once again, anxiety attacks that were getting worse. Began therapy with a psychologist, she left, saw another one, still was getting worse.
She was on leave for a few months and her office felt I would be fine with some time off. Not exactly. Found my current therapist(s) near my home and I've been progressing forward. Its taken a enermous committment on my part, meeting sometimes 4-5 times/week, and while I'm taking two scripts in small doses, I've made much progress in identifying the internal causes of my strife.
My best bud who is also in a similar situation continues to up the dose of his scripts as he feels he doesn't have time for therapy. Ironic isn't it.
Remember though that a psychiatrist is also an MD whose "job" is to find a prescription that the client may benefit from so they can work on identifying the causes of the issues with their therapist, or psychologist. That is one thing a "pill" can't do, is find a solution.
Hi Rick
What an insightful comment! Yes so true...a pill can only do so much. It won't give you the coping skills you need or mend your relationships...or get you a job. They can help but...it is only one tool we have in our arsenal to combat the symptoms of depression and/or anxiety. I really think talk therapy can help as I can attest to from my personal experience. It takes work though as you say...you can't just sit there and expect miracles or for someone to "fix" you.
Thanks so much for taking the time to respond. I really appreciate it.
The posts I've read here share many great insights and experiences. I can relate! I've had about 30 years of talk and psychiatry therapy, and I've been helped by much of it. Of course there has been a share of incompetence for both disciplines, and those times are scary. I've been diagnosed, misdiagnosed, rediagnosed to where I admit I have developed a mistrust for this area in general. However, I've had good experiences too. Right now I have been seeing a therapist for two years who guides me in bringing the unconscious painful emotions and memories into consiousness, to let the pain heal, and as I have found, actually change a behavior associatied with that memory. Next to prayer, it is the deepest form of healing for me, and it took tremendous trust-building with my therapist. She is a wonderful guide in the process.
I think CBT has a good place in the spectrum of therapies for me. I learned it early on when the depression, anxiety and cutting desires and suicidal ideation first started. I call it the meltdown. I was 24 yrs. old.
Once learned, I used CBT without therapy to extinquish the fear of heights, bridges, elevators, escalators, and more. Feeling that I myself could overcome these tremendous anxieties gave me a small sense of personal power within. I still use CBT today if I feel it is needed.
Psychiatrists are an odd and expensive lot to me. I am not easy to treat because I am refractory to anti-depressants. Frankly, I have developed a bad attitude because who's running the show - their skills and heart or their insurance manipulation and greed? After one to a few visits and a look at my insurance company's payments I can tell. As I write this I can feel the utter frustration rising in me so please accept apologies for any negativism. Right now I am without a psychiatrist and very much in need one, but as one medical doctor here told me, "good psychiatrists are 'slim pickins' in this area.
This site is a so helpful tool. I find good people, great support, many insights, practical information and HONESTY! MM, I've missed you.
Best to everyone, Gina
Hi Gina!
You are a sight for sore eyes. I have missed you too. How are you doing?
Hey...you aren't negative...you are merely stating the facts and the reality of what you have experienced. I must admit...I am becoming jaded myself.
I definitely want to hear more about the cognitive therapy techniques you have learned...I still have a major fear of heights.
Please don't be a stranger. You know we love seeing you here.
From my experience I have to say that "Talk therapy" in the region where I live is growing. Tonite I was at Co-Dependency group therapy and 11 people showed up. We always have 11-14 people in attendance. While its group, with a cost of $30 for 2-hours in my opinion it is a very strong group. It does only last 12-weeks but for me I can relate it has helped me tremendously. Its comforting to know that while it seems everyone has the perfect life on the exterior, its just not like the "Brady Bunch family." For me I actually thought that is how families other than mine lived. Really.
The other group is a transgender group, and while its informative and thought provoking, the attendance is very sporadic. I've never missed, as we only meet with the therapist once every four weeks, but it appears for the other attendees it does not have the importance. I'm trying to understand myself, where it appears some of the others attempt to sway you into feeling how they felt or are feeling. I don't know how many times I've been labeld as not being authentic or in denial of who I am. I'm me, just a guy, who has the hobby you can say of dressing as a female. Maybe its a stronger feminine side. Not that there is anything wrong with that. This is something that drugs would have never allowed me to admit. 
Thanks for sharing these experiences...I think maybe group therapy is something more of us should look into...it does appear to be at a much more affordable rate. I think groups can be variable...as you have found in who can attend and what you can get out of them. At one point I signed up for group therapy but not enough people joined.
Please do keep writing about your experiences and what things help...this is all very beneficial to our other members.
My visits to my psychiatrist are exactly as described in the article. However, I now know when I need to go back into therapy, so I search out therapists on my own. I've found several over the years (including one who I think should have his license pulled, he was so bad), and I've been lucky enough to find good ones who've really helped. I have to say, though, that the last therapist I saw was the only one who not only helped me through the "putting out weekly fires" stage, but continued to work with me for two years following my latest crash in order to teach me new coping mechanisms, something no other therapist had done for me. I firmly believe that that therapist literally saved my life. My medication keeps me functional, but it's the talk therapy that gives me new hope!
May the gods bless all therapists who genuinely care for their clients, and are willing to work with them for as long as is needed!!!
My husband is a Phd Psychologist. He is the only Physchologist I know that does talk therapy and if the patient needs meds he refers them to a Psychiatrist. He has been a Psychologist for 30 years and he loves his patients and does everything he can to help them. If they need Physical Therapy, he refers them to a Physical Therapist, if they need other kinds of doctors he refers them. He goes out of his way each day and makes sure the patient has all the things they need to get better. There are not enough Medical Therapists, the insurance companies havedestroyed the profession and all the Psychologists are running for the hills. The insurance companies keep lowering their fees and telling them how many sessions they can give patients. We need to start complaining and let the Health Insurance Companies they are not doing anyone any favors.
The mental health parity law was passed last year, I believe, that makes insurance companies cover mental health care to the same degree as any other medical care; i.e., they're not supposed to be putting annual dollar caps on services or on the number of visits. However, I think they still will require evidence of "medical necessity" but that's probably the case for most treatments of any kind. I think there are some exceptions; for example, if your insurance company didn't cover mental health, it doesn't have to now and also, some small businesses under a certain number of employees may not have to conform. However, it's progress! The senator who initiated this bill is from my state, I am proud to say. Where I live, we have many, many psychologists who do therapy. In fact, Medicare won't cover therapy unless it's done by a Ph.D. My own psychiatrist even does therapy, although I don't use him for that because I already have a therapist.
I have been fortunate to get a referral from a social worker to a group therapy session. Eight to 10 of us meet weekly to "check in" and talk. The therapist said recently that a group like this didn't exist until he came and started it. All other groups are instructional, without a chance to talk. I've gotten better mental health treatment in the last year than in the ten years previous. The stories I hear from some of the other participants mirror the comments I've seen here about psychiatrists and meds.
I have three children with various mental illnesses (ranging from bipolar to anxiety disorder to OCD to psychosis) that require therapy AND medication. Unfortunately, I live in an area where the mental health services were not good to begin with, then we had a natural disaster where many of the professionals who could afford to do so, relocated, and six years later we are still suffering with long waiting lists and subpar services.
In addition to the aggravation of finding a mental health professional who even accepts your insurance, we have the problems of patching together the services in order for each child to get the therapies and prescriptions that they need and often facing months-long waiting lists to get a particular service.
Currently my daughter, who has Fetal Alcohol Syndrome and is mildly MR, severe anxiety disorder, encopresis and ADHD is on a waiting list (for two months now) to see the same psychiatrist that her brother sees. He got in after waiting six months on the list (with out of control bipolar disorder) a little over two years ago. My daugher sees a behaviorist, a gastroenterologist and a psychologist for her bathroom issues, but we need a psychiatrist that can not only prescribe her meds, but also oversee all of her care, so that we are not working in opposite directions with the various specialists. (We have her seeing a psychitrist for now, but he doesn't take insurance and it's $125 cash for 15 minutes!) I think in the mental health field this particular services is seriously neglected - the one person who can look at what ALL the specialists are doing and guide everyone in the right direction - or at least make sure no one is inadvertantly working in the opposite direction.
So I take a child to the psychiatrist to get his meds, his occupational therapist to get his OT, his psychologist for his talk therapy and his behavioral specialist to work on different behavioral strategies (and don't think they are in the same building - or even the same city - or have appointments on the same day). That's not including the education specialists where we have him assessed and he works to overcome his learning disabilities and ADD. Sheesh.
It would be a dream come true to have a "one stop shopping" system where my kids could get their talk therapy and behavioral therapy and their prescriptions all from the same place, if not the same doctor. But unfortunately, the trend of insurance companies has been to parse everyone into different pieces. I'm constantly trying to piece together the services they need - like a quilt. It's exhausting and expensive and sometimes I really mess it up and I want to give up. And I have a college degree! I can only imagine how overwhelming this is to the folks who have limited abilities or resources. We're lucky in that we have health insurance that covers part of the services, but you practically need a math degree to understand what percentages of which services and what are covered vs. non-covered expenses and what the Usual Customary Rate is. We're never quite sure what we will be expected to pay.
Bottom line, for people who need mental health services, our system is seriously in need of an overhaul. Families who deal with mental illness have enough on their plates without having to face long waiting lists with no services, 5 minute in and out "appointments" and fighting the insurance companies.
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I am also concerned about the treatments, or lack of, in the mental health field. A few years ago whenever I saw my pdoc, my copay was different each time. I used to tell the receptionst to "spin the wheel." My visits last about 5 minutes. He gives me my shot and "pay on the way out!" One day about 2 years ago, my pdoc told me he would not do therapy for me...here's a script..see you in two weeks and make sure you bring your checkbook. My "express lane pdoc" charges my insurance a lot more than necesary for a visit. One charge is $40 -$50 for the shot, (which I provide) and another $120.00 (it was $100 but the first of the year he upped his price) for "diagnostic services" for 5 minutes!! The reason he does that is my insurnace won't pay for the $40 shot but the $120.00 they pay part of it. My 5 minute visit totals around $200! He has a sign in the waiting room that says $100.00 a visit. He then charges my insurance $200!!
There were times when I go see him and sales rep from a drug company would come in and he'd take them first!! Another time his wife/receptionist charged me more because I was in his office for 10 minutes! He graciously lets me only pay part of my copay. That makes it right?!?!?
The system is broken. Its getting worse too. No talk..here's a pill. "pay on the way out will ya! This is sickening.
David
Hi there
I am so sorry. You must feel so frustrated. I believe you are right...much of the system is broken and I am not sure what will fix it. The revolving door system of mental health services just doesn't work.
Thank you so much for sharing your story here with us.