The True Cost of Therapy

One of the first questions people have when inquiring about therapy is “does your practice accept insurance”. The answer is no. We happily provide a receipt for out of network benefits but we do not interact with insurance companies. This often gets a wide array of responses…most of which are negative.  There are concerns about the cost of insurance, that we must not care or that we are more interested in money then we are about the mental health of people in need. That cannot be further from the truth. There have been plenty of times that I have had conversations with my husband about accepting insurance, and while I often have the fortune of getting things the way I want in our relationship, this is a point he won’t budge on.

This past year I had the opportunity to truly understand the cost of therapy. I say opportunity when most people would say misfortune because I now get why my husband will not accept insurance. Hopefully after reading this, the next time you or someone you know is seeking a therapist, more consideration will be given to an out of network provider.

Now for the history. My husband and I met more than 15 years ago while working together in prison. He was a psychologist over the inpatient mental health units and I was an administrative assistant in the psychology department. I was working full time while finishing my degree in administration of justice and political science with the goal of going to law school to be a prosecutor. I was 21 years old, very stubborn and, from what I thought at that time, very emotionally tough. I loved working in the prison. I loved reading classification charts of crimes. I loved sitting in on psychology meetings and learning about the seriously mentally ill inmates that my now husband worked with. In school, I loved my forensics class. Seeing autopsies and crime scene photos was fascinating at that time.

Fast forward a few years.  My relationship with my now-husband was becoming more serious and my dreams of becoming a prosecutor were being replaced with being a wife a mother. I started questioning if being in that line of work was conducive to the family life I also wanted. While I know there are plenty of women who balance being a prosecutor and a wife and mother, I decided against it. Instead I decided to pursue nursing. I started an accelerated nursing program right after I returned from my honeymoon and graduated a year later while seven months pregnant with my first child.

Like many new nurses I thought that because I was an RN now I knew a lot more than I really did. I didn’t need to take childbirth or parenting classes. I just finished my clinicals where I took care of postpartum moms and babies for some time. So off to labor and delivery I went. After a very easy pregnancy and in hindsight easy delivery we welcomed a beautiful baby girl to our family. She was born at 10:23pm which is significant because, now as the knowledgeable L&D nurse, I know that this time is a huge strike against first time moms. See, if you deliver any time before midnight that counts as your first night in the hospital. As a first time mom that means I was discharged in about 36 hours. Cue skyrocketing  anxiety.

In hindsight, I am confident I had postpartum anxiety that needed treatment. At this point you might be thinking “well your husband is a psychologist wouldn’t that help or didn’t he notice”. My husband would have been very supportive of me going to therapy, but the key to therapy is that you cannot make someone who is not ready to go, go. I was not ready. I was however also not enjoying motherhood the way I could have. I stared at my daughter’s every breath, fearing that she would stop breathing; and if she stopped, I was certain I would too. The first year of her life, probably longer, was filled with so much angst that I really missed the enjoyment of all the amazing milestones that were occurring.

As she grew, my anxiety lessened, but I never learned coping skills. I continued to push forward accumulating more and more unhealthy mental health habits. By the time I had my second child there were some things that were better and some that were worse. I was now working in labor and delivery full time nights. My shift was from 7pm-7:30am three times a week. I was tired, irritable, still anxious and vulnerable to something happening to them and still not truly enjoying life.

When my kids were 5 and 3 ½ my husband and I started talking about expanding his practice. I thought this was a great opportunity to incorporate my passion for childbirth education with mental health care for new parents. I would often share stories with my husband about my days at work, talking about the many moms I knew were going to wind up filled with anxiety just like I was.  We decided to push forward with this new business venture. Being an anxious person, this was both exciting and terrifying for me. What if it failed? What if we lose our money? What if .. what if.. what if??

Right before signing the lease to our office we found out we were expecting our third child. I powered through the pregnancy without a thought. I was building this business and it was going to be successful. I spent days super pregnant with two kids in tow waiting for furniture, developing programs, setting up offices. By the time we opened in September I was convinced that I would give birth in October and be up and running at the office immediately.

Enter anxiety again.  Enter the fact that I still never received any “formal” treatment for my anxiety. Enter the stress of three children, a business and house and a high stress floor nursing job. Enter the straw that broke this camel’s back.

I don’t remember the exact date, but I went to work in labor and delivery like I had done countless times before for the past seven years. This day was going to be monumentally different though. This day is the day I experienced a mother die. A mother of a brand new baby, who also had a small child at home. She died of an amniotic fluid embolism. There is nothing that could have been done to save her. At the time I thought I was handling the events that occurred in front of me the way I did back when I was in college watching an autopsy. I, with other nurses that I work with, removed the tubes from her now cold, gray body. We cleaned her and performed postmortem care. As I was driving home that night I began to feel as if I was going to pass out. Realizing that I had not eaten in many hours I pulled over and had a snack, not realizing that this feeling had nothing to do with hunger but everything to do with trauma.

That night I processed the events that occurred with my husband, the psychologist. I cried knowing that the child that woman had would never get to see her mother again. That for the husband I was making small talk with while I took to another room as we were desperately trying to revive his wife, life would never be the same. I thought that after going over these events I could move on like any other day. When one of my managers reached out to me offering me employee assistance, I declined thinking again that I was “over it”.

Unfortunately for me I was off from work for the next two weeks. During these two weeks several things happened that were, unknowingly, detrimental to my dealing with this. I was away from the hospital, so I didn’t need to face my fear. When I drove I started noticing that I felt weird, like a fogginess or a strange sensation was in my head. My husband also fell ill with a virus and was incapacitated for a few days, which is very unusual for him.  So the timing of his being “off”, made things seem worse.

The morning of 12/2/2015 started off like any other morning. I got the kids ready for school, my husband was still ill at this point and I nagged him enough that he went to the doctor. Right after getting my middle son on the bus I received a phone call from my husband. The doctor was sending him for bloodwork and an ultrasound. Consciously I thought “what a waste he just has a virus”.  Subconsciously, my world was falling apart. As I started driving, with my 1 yr old strapped in his car seat, I approached a busy intersection and panic hit. I was going to pass out.  My heart was beating out of my chest.  I couldn’t catch my breath.  I was cold and sweating. I found somewhere safe to pull over and I called 911. My husband came to the scene and was able to take my son to my parents as I was being whisked away to the emergency room.

At the emergency room, all my tests were negative. EKG was perfect. Lab work pristine. I could not comprehend how that could be when I was certain that I was about to die. Once my husband started putting it together he realized that I had experienced a full-fledged panic attack. He asked the ER doctor to give me Xanax to see if it made me feel better. Sure enough for the rest of that night I was fine.

The next morning as I was feeding the baby back came the racing heart, the sweating and feeling as if I was going to pass out. I was now convinced that there is no way that this was anxiety. I knew I had anxiety in the past and this was not it. I went to my primary care doctor. Diagnosis: anxiety. EKG perfect again. This time I left with a prescription for Xanax, which I knew was only a short-term fix. I knew I could not continue like this. Enter therapy.

I setup up appointments with both a therapist and psychiatrist. I realized the value of both. I had to because I was in crisis; which is unfortunately the time most people wait until to realize the value of therapy. By going to an out of network provider, we could come up with a treatment plan that worked for me. What many people fear when starting therapy is that it is going to be a never-ending road. That should not be further from the truth. In fact, if you begin therapy when a problem first arises instead of waiting until it is a crisis, you are more likely to be able to minimize the amount of treatment you need. I was able to put my sessions on a credit card (which earned us airline miles at the same time which was an added bonus) and was reimbursed for 70% of my session fee. Ultimately, I paid slightly more than my regular co-pay but have been able to see a higher level professional. Whether you like to hear it or not, not all therapists are the same. Doctoral level psychologists and psychiatrists receive many more hours of clinical practice and supervision, as well as having much longer amounts of schooling than other mental health professionals.

Over the course of the year, I not only dealt with the trauma that pushed me to have panic attacks but also many of the unhealthy mental health habits I had developed over the years. I came to terms with the fact that much of my anxiety (as is true for most people) revolves around the loss of control. Seeing someone die in front of you is the ultimate realization that we are not in control. Each day you wake up, there is a chance it could be your last day. What I am learning is to embrace that. To practice self-care, to be mindful, to celebrate things that I would have never celebrated before. Does it mean I am perfect now.. not a chance. I still have periods of anxiety. I still yell at my kids and do not enjoy every second of motherhood, but I am so much happier and healthier than I was before this whole journey began.

 

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