May is Mental Health Awareness Month! To celebrate, we’re diving into everything you need to know about mental health, including what therapy actually looks like, the cost, and the different types of mental health care.
1. How do you know when to get mental health treatment?
Most people could benefit from therapy at just about any point in their life. There does not need to be a crisis in order to seek counseling. Often people will notice more physical signs first—trouble falling asleep or staying asleep, heart palpitations, feeling they can’t turn their brain off, being easily distracted or not being able to give something your full attention, wanting to disconnect or isolate. For others they might notice apathy where there usually wouldn’t be, or fear or worry they just can’t shake. They might not notice it themselves, but someone they trust tells them they seem different, not well, or not themselves.
These can all be signs to reflect on when deciding if talking to someone outside the situation could help. Often people will tell me that they don’t feel their problems ‘are big enough’ for therapy. However, once we start to talk it’s clear there is messaging, often created in childhood, that is impacting their current functioning. This could include themes of being lovable or good enough that get in the way of being in a healthy relationship/friendship or that impact work, pleasure, or rest.
2. What does therapy actually look like and how does it work?
For most, therapy starts with an assessment, with the goal of taking a look at your history and how it might be impacting the current problem. Future appointments will focus on how your feelings, thoughts, and behaviors intersect, and what’s working and what’s not.
An example case is a client that comes in saying his girlfriend complains that he is quick to anger. In therapy, we would look to what led to that feeling of anger, what you did with that feeling, and then examine if that is working for you. We might start to look at your thoughts surrounding getting angry—maybe not wanting to be like your father who had explosive anger or maybe feeling pushed to talk before you find the words. In therapy, we would talk about those thoughts and learn how to replace them with more accurate ones, like “I won’t be my father because I am getting help for my anger, something he was never willing to do.” We would identify physical clues that anger is coming up so that you can implement a calming behavior and verbalize the need for space to calm down and collect your thoughts. I always remind clients that recovery is the most important part. We’re not saying you will never show anger again, but when you do, you’ll know how to identify and correct it in a way that won’t hurt your relationships.
Another example might be a client whose mother always criticizes them. Now, we can’t change your mother in therapy, but we can change how much time or energy you put into that relationship and how you allow it to impact you. In therapy, we might learn how to set firmer boundaries, when to leave or not engage in a conversation, or how to work towards not allowing it to impact your feelings.
Can’t both of these examples be helped by simply talking to a friend? Although a friend might be an easy way to talk through your situation, it can sometimes lead to harmful advice. They might say ‘it’s easy, just don’t get angry’ or ‘but she is your mother, you owe her your time.’ Both statements belittle how you feel or make you feel silly for finding your situation challenging. A therapist can help you go deeper into where the feeling might be coming from and how to identify it, often helping you have empathy for yourself and making it easier to actually problem solve or learn new skills.
3. How long do I need to be in therapy?
The length of therapy really depends. For some, we’ll just see them a few sessions to work on a very specific issue, but for others it might be long-term. Most clients decide when they are feeling better enough to stop therapy, but there also may be times when the therapist feels it’s time to terminate therapy. The goal of therapy is to not need therapy anymore—to have the tools and skills to be able to continue to do the work on your own.
4. How much does therapy cost?
This again varies greatly. Therapy can cost whatever a therapist wants to charge as there are no rules or laws on how much can be charged, outside of insurance. Most insurances have either a coinsurance or copay. For most insurances you have a traditional copay, which can range from $0-$100. If your copay is higher than the negotiated rate (what the insurance pays the therapist), you only owe the negotiated rate.
If you have a high deductible plan, you are responsible for 100% of the negotiated rate until you get a deductible, then it will go to a percentage. For example, let’s say the negotiated rate is $100 and you have a $1,000 deductible then a 20% coinsurance until you hit a $5,000 out of pocket maximum. In this example you would pay the therapist $100 per session for the first 10 sessions (until you reach the $1,000 deductible), then $20 (using the 20% coinsurance) until you hit the out-of-pocket maximum of $5,000. After that it would be $0. Also, remember that most deductibles and out of pocket maximums include all your health costs, including your other doctors, surgeries, and sometimes medication, so you may reach your deductible and out-of-pocket maximum even sooner.
5. How does telehealth work?
There have been a lot of questions about telehealth as of late. Although telehealth is virtual, there are still limitations based on location, specifically where the client is located. The state of Florida requires the client to physically be in Florida to be seen via telehealth by a therapist licensed in Florida. However, the therapist can be in another state during the session. Likewise, if a client lives in New York for several months of the year, they can only see a therapist who is licensed in the state of New York while they are physically in New York.
Though it might be tempting to do a telehealth appointment just about anywhere, it’s best practice to be in a private space with no one else around. This does not include a moving car, a coffee shop, or a living room where your children could be hiding off camera. This is because we cannot control confidentiality in these locations, and we may say something that you might not want overheard by strangers or your family. We ask that you treat a telehealth session like an in-person session, with a private space with no one else around.
6. What is the difference between coaching and therapy?
You may have heard about the growing popularity of life coaching. Life coaching focuses on short-term goals and how to achieve them, at times growing skill bases for future goal completion. Life coaches do not hold state licenses, they do not have a board to file complaints if there are problems, and there is no standard education required to become a life coach. Anyone for any reason can call themselves a life coach.
Therapists on the other hand have standard educations, a master’s degree at a minimum, and have licenses and boards to file complaints if issues arise. There are also ongoing requirements for licensure to ensure that therapists are up-to-date with ethics and ongoing education. Therapy is covered by insurance, whereas life coaching is not.
Types of Mental Health Care
Inpatient Hospitalization
The goal of inpatient hospitalization is not necessarily treatment, but to keep you safe from harming yourself or others. Inpatient can be both involuntary and voluntary admission. Often people are disappointed thinking they will receive intensive care, but find rather they are mostly just monitored while watching tv or other activities. You will see a psychiatrist at least daily which does help with faster medication changes. Some group therapy will also be conducted to ensure you have better coping skills to not return to needing that level of care. Hospitalization usually lasts between 1-7 days, most leaving with 2-3 days. There are procedures that must take place for a longer than 3-day hold, which makes it less likely to be kept that long.
This type of care is important if you or a loved one cannot keep themselves safe or cannot guarantee they won’t hurt others, so much so that you call the police, their physician, or their therapist to initiate the Baker Act. Although this can be hard, remember, it is better to have someone alive and mad at you, then not mad at you and deceased.
Residential
The goal of residential therapy is intensive round-the-clock therapeutic care. Most days entail individual and group therapy, skills groups, educational group, family/couple therapy, and activities which might including physical fitness and entertainment. There is usually a psychiatrist on staff who you can see as often as needed. You will stay there to sleep and on weekends.
This is an appropriate level of care for people that are really struggling with most areas of their life, but are not a threat to themselves or others. Often, we can work with employers to get time off to seek treatment through FMLA if the client is currently working, though at this point people might not be able to work due to the severity of their condition. Residential is often covered by insurance but there can be aspects that are not covered, like airfare or aftercare, and you must find a program that accepts the specific insurance you have. Oftentimes people come out of inpatient hospitalization into residential care. Residential often is 21-28 days depending on severity and insurance coverage.
Partial Hospitalization
The name can be a little misleading, but partial hospitalization (PHP) is where you go 3-8 hours a day, 5 days a week, but you stay home at night and on the weekends. Like residential, you will do different types of therapy and activities, with the major difference being you go home at the end of the day. There is usually a psychiatrist on staff who you can see as often as needed. This is considered a step down from residential, as people often go into PHP after residential care.
PHP is a little more flexible for timing, sometimes we only do a few weeks, other times, usually do to lack of residential coverage, it might be longer. You can enter PHP treatment directly without having to be in the hospital or be in residential. Again, insurance coverage is likely there initially, but you have to meet criteria to continue and often the insurance will want you to step down as soon as possible.
Intensive Outpatient
The goal of intensive outpatient (IOP) is to get you ready to go down to just outpatient therapy/medication management. IOP is often at the same time with PHP, but only 3 days a week for less hours. Many programs run both PHP and IOP at the same time, just those staying for one program may stay later or have only certain days they are there versus others. Several programs also have evening IOP that accommodate work and school schedules. You can initiate care at this level as well if you feel that you need more than weekly therapy but not necessarily 5 days a week.
Again, focus is on therapy, group therapy, skills, and medication management. Insurance often covers this as well, though I have seen some instances where they require PHP or a recent hospitalization first to qualify.
Outpatient Treatment
This is what most people think of as mental health treatment, outpatient therapy, group therapy, or medication management. This is usually weekly for therapy or monthly for medication management. During outpatient therapy, you and your therapist will work together to create a treatment plan and will work together to complete those goals, such as better selfcare, setting boundaries, processing and creating meaning from past trauma, or finding more joy or meaning in your life.
Insurance covers this type of care, but it might be challenging to find providers who accept insurance as many do not. It might take a few phone calls to find a provider who is taking insurance and new clients, but do not let this deter you from treatment! Your employer may have an EAP program (Employee Assistance Program) that can help you find and pay for a few sessions, usually 3-10. Even if you do not get insurance through your job, you still may be eligible for EAP. It’s best to reach out to your HR department/benefits manager for further information. You may also be eligible through a spouse or parent. All therapy, including EAP, is kept confidential from your workplace.
Looking for more tips and guidance? JFS Orlando’s counselors are specialized in various areas and are here to support you. Telehealth counseling appointments available! Medicare, Medicaid, and almost all insurances are accepted. Sliding scale available for those who do not have insurance or have an insurance we do not accept. Call 407-644-7671 or complete our online form to request an appointment today!
Ashlyn Douglass-Barnes, LCSW is the Clinical Director and a licensed clinical social worker at JFS Orlando. Ashlyn has worked in a variety of settings including outpatient community based mental health, inpatient/admission psychiatric hospital, substance abuse/DUI, dialysis/medical, and in home/office outpatient therapy.