Private mental health providers in the US are pretty unsupervised and have a conflict of interest in that they make more money by keeping their patients/clients unwell, which can lead to negligence and abuse. The only thing keeping in line is the possibility of someone informed and insightful enough to report them to the licensing board or pressing a lawsuit.
For example, if a provider has poor integrity, it is in their best interest to not treat depression, but rather help the patient/client feel good for the moment. What the patient/client experiences is that they feel better when they see their provider, so they become dependent on their provider. This ensures the provider a reliable source of revenue.
Another issue is that masters level therapists, while capable of providing treatment for simple cases such as a clear depressive episode, are not properly trained to conduct thorough assessments for complex cases, meaning they can misdiagnose quite easily. Complex cases would be better treated by a well-trained psychologist that can conduct thorough psychometric assessments that are quite sophisticated and take lots of time to analyze. These services are costly and the vast majority of insurance policies won’t cover them.
Relevantly, yet another issue is insurance for mental health. Most insurance policies that pay for mental health services pay low, so the care you receive can be substandard since the more effective providers are charging what they’re worth in a market economy. One example that comes to mind is Better Help. They pay providers insultingly low, like around $30/hour, while effective providers are charging ~$150/hr out-of-pocket. That means that when someone uses Better Help to obtain care, they’re getting the bottom of the barrel therapist.
Lastly, the majority of family and marriage therapists aren’t properly trained in narcissistic emotional abuse. This can mean that therapy would not only be a waste of time, but can make things much worse as they can help the narcissist abuse the victim even further. Narcissistic abuse is quite complicated and requires a relationship therapist that specializes in that to properly assess and help the victim escape.
Tips: If you have been seeing a therapist for 12 sessions, and you haven’t realized any considerable long-term changes, find another therapist. Also, if your therapist doesn’t call you out on your bullshit, let’s you ramble about tangential matters, or focuses on helping you overcome specific weekly struggles, rather than helping you develop skills and restructure deep cognitive matters to address them yourself, find another therapist. An effective therapist would develop a clear treatment plan with you that aims to meet objectively measurable goals within a certain time frame.
Note: I am not a therapist. I have just worked in the mental health field and have friends that are therapists.
An effective therapist would develop a clear treatment plan with you that aims to meet objectively measurable goals within a certain time frame.
This is a great point and true for non-therapists as well. A good measure of whether or not someone helping you is providing you value is if you are progressively improving in measurable ways.
True for doctors, meds, physical therapists, coaches, you name it
Part of the problem with this is no clear treatment plan works consistently for everybody. Insanity is as diverse as cancer, and even the DSM is used as a rough guess as to what is going on, based on what mix-and-match set of symptoms.
Each psych med takes a month to start, get stabilized and see if that’s an improvement. If it doesn’t work right (typical) then the options are to add another drug (and then more drugs to counter side-effects) and test it as a cocktail, or get the patient off the first drug (usually two weeks to get sober, during which they’re symptomatic) and another month to start something new. I went through over a dozen SSRI combinations and for a while had to settle on a cocktail that wasn’t terrible and was slightly less bad than going sober.
Then there’s a matter that we often cannot escape the toxic situations we’re in, whether we can’t move out of a situation with contentious roommates or are working for a company with cruel middle management and scary toilets and stinks of insecticide. I’d think any physician might argue that someone with a lung condition should be moved out of the moldy house they live in, but when it comes to environments that are psychologically unhealthy, we’re all expected to just deal.
And this informs my job in the psychiatric sector which is as a peer councilor. When patients are stressed out and their professionals aren’t doing it for them, they come to me, and the first think I ask is are you safe? Most of the time, they are – as with the rest of the US population – in precarity, sometimes not even knowing where their next meal is coming from or if they’ll have a place to live next week. But scary parents, scary roommates and scary bosses are also super common, and we’re not really going to be able to treat or even manage the crazy when people are fearing for their survival.
During the pandemic, this company was heavily advertised across Twitch. Not surprised they pay shit wages. Wonder if they originally paid 2-3X market rate during the hype, but slowly clawed back the teaser rates in favor of the dog shit rates.
I heard all the bad shit about better help. But I had been interested in therapy so I tried to find a therapist from a local person instead. Found out my bill was nearly $200 a session. And since therapy isn’t something like an annual doctor visit or a twice a year dentist visit, I noped out of that.
So I more than understand why people choose Better Help. It’s often actually affordable.
This is very accurate. I worked 5 years in a BH Insurance company. We saw shitty providers all the time, and we were constantly having to play the game of deciding how much we (and our members) could tolerate before cutting the providers out of the network. Cutting too many providers doesn’t correct bad actors or replace providers for people who need them and can cause backlogs if other providers aren’t available to take on their patients.
The only thing we were able to do to correct many providers by changing their pay to a value based model, so providers would get paid more for better outcomes (and sometimes only paid when patients improve). It would increase pay a lot over standard rates. But providers fought that big time. They just wanted to do things their way and cash a check of a set amount with little or no oversight.
Better help is used by providers as a way to supplement their income, and they typically pay a bit less than conventional appointments because of the digital channels. However, Ive heard they have some issues with data security on their platform and their matching system is pretty flawed due to their network being somewhat ephemeral.
If you do want to seek therapy, remember you have multiple ways to get it covered. Your health insurance probably has some coverage, and your employer (in the US) likely has an EAP program which will have coverage for therapy for at least a few sessions (typically 3-12) sessions. It’s worth looking into that before paying out of pocket.
I have lifelong major depression, and got myself integrated into the mental health system of San Francisco (one of the better municipal systems available in the States). Since my insurance was government or state, it typically meant that I’d see interns for a year before they graduated and started their own practice. A friend of mine and I would joke that we were trainers in that our life drama was severe enough to convey to our trainees that life shit is real and that sometimes there are real risks (suicide, stalkers, toxic violent parents, etc.) but we personally were not likely to become a danger to ourselves or others short of natural disasters.
I also got to crush egos because it’s not like the movies where the patient has a good cry and then is better. I’ve done a lot of crying and I’m still depressed as ever (more so as the world is literally burning, which limits my hope for a better future). I can manage my symptoms more or less, but I’m never going to be a happy self-sustaining good little citizen. And curiously, some of them see that as an end goal: You get Will Hunting to have a good cry and he’s fixed. Not so much.
I eventually got lucky, and was able to find one of my old interns and resume with her while she was working on her PHD. I was a case in her thesis and got an ASD diagnosis out of it in my late forties (it’s not helpful yet for navigating benefits, but is useful regarding directing my own symptom management). But most of my career as a patient is spending more than half a year getting my therapist familiar with my case and then the remaining months squeezing a bit of process out of it…
…Or just goofing off, since I absolutely have personal demons that don’t want to be closely scrutinized, so it becomes too tempting to let my therapist get distracted by details that are entertaining to them. (My history in the BDSM and my burgeoning queerness are fun topics, as are my awareness of issues like the climate crisis, the plastic crisis, the police state, the surveillance state, the transnational white power movement and its uprising and takeover – all of which were still commonly regarded as conspiracy theories / fringe hypotheses when I was in session.) Sometimes, we patients are so terrified of what our closeted shit says about us that we’re not ready to open those doors. And sometimes the therapist doesn’t want to look either, so we negotiate a diversion we can agree to distract us until later.
I stopped going to therapy shortly before the COVID-19 epidemic outbreak and lockdown so I get to start all over again in Sacramento. Hopefully, I’ll find a permanent therapist (and a good match) early, but I suspect I’ll be back to seeing interns again.
Private mental health providers in the US are pretty unsupervised and have a conflict of interest in that they make more money by keeping their patients/clients unwell, which can lead to negligence and abuse. The only thing keeping in line is the possibility of someone informed and insightful enough to report them to the licensing board or pressing a lawsuit.
For example, if a provider has poor integrity, it is in their best interest to not treat depression, but rather help the patient/client feel good for the moment. What the patient/client experiences is that they feel better when they see their provider, so they become dependent on their provider. This ensures the provider a reliable source of revenue.
Another issue is that masters level therapists, while capable of providing treatment for simple cases such as a clear depressive episode, are not properly trained to conduct thorough assessments for complex cases, meaning they can misdiagnose quite easily. Complex cases would be better treated by a well-trained psychologist that can conduct thorough psychometric assessments that are quite sophisticated and take lots of time to analyze. These services are costly and the vast majority of insurance policies won’t cover them.
Relevantly, yet another issue is insurance for mental health. Most insurance policies that pay for mental health services pay low, so the care you receive can be substandard since the more effective providers are charging what they’re worth in a market economy. One example that comes to mind is Better Help. They pay providers insultingly low, like around $30/hour, while effective providers are charging ~$150/hr out-of-pocket. That means that when someone uses Better Help to obtain care, they’re getting the bottom of the barrel therapist.
Lastly, the majority of family and marriage therapists aren’t properly trained in narcissistic emotional abuse. This can mean that therapy would not only be a waste of time, but can make things much worse as they can help the narcissist abuse the victim even further. Narcissistic abuse is quite complicated and requires a relationship therapist that specializes in that to properly assess and help the victim escape.
Tips: If you have been seeing a therapist for 12 sessions, and you haven’t realized any considerable long-term changes, find another therapist. Also, if your therapist doesn’t call you out on your bullshit, let’s you ramble about tangential matters, or focuses on helping you overcome specific weekly struggles, rather than helping you develop skills and restructure deep cognitive matters to address them yourself, find another therapist. An effective therapist would develop a clear treatment plan with you that aims to meet objectively measurable goals within a certain time frame.
Note: I am not a therapist. I have just worked in the mental health field and have friends that are therapists.
This is a great point and true for non-therapists as well. A good measure of whether or not someone helping you is providing you value is if you are progressively improving in measurable ways.
True for doctors, meds, physical therapists, coaches, you name it
Part of the problem with this is no clear treatment plan works consistently for everybody. Insanity is as diverse as cancer, and even the DSM is used as a rough guess as to what is going on, based on what mix-and-match set of symptoms.
Each psych med takes a month to start, get stabilized and see if that’s an improvement. If it doesn’t work right (typical) then the options are to add another drug (and then more drugs to counter side-effects) and test it as a cocktail, or get the patient off the first drug (usually two weeks to get sober, during which they’re symptomatic) and another month to start something new. I went through over a dozen SSRI combinations and for a while had to settle on a cocktail that wasn’t terrible and was slightly less bad than going sober.
Then there’s a matter that we often cannot escape the toxic situations we’re in, whether we can’t move out of a situation with contentious roommates or are working for a company with cruel middle management and scary toilets and stinks of insecticide. I’d think any physician might argue that someone with a lung condition should be moved out of the moldy house they live in, but when it comes to environments that are psychologically unhealthy, we’re all expected to just deal.
And this informs my job in the psychiatric sector which is as a peer councilor. When patients are stressed out and their professionals aren’t doing it for them, they come to me, and the first think I ask is are you safe? Most of the time, they are – as with the rest of the US population – in precarity, sometimes not even knowing where their next meal is coming from or if they’ll have a place to live next week. But scary parents, scary roommates and scary bosses are also super common, and we’re not really going to be able to treat or even manage the crazy when people are fearing for their survival.
During the pandemic, this company was heavily advertised across Twitch. Not surprised they pay shit wages. Wonder if they originally paid 2-3X market rate during the hype, but slowly clawed back the teaser rates in favor of the dog shit rates.
I heard all the bad shit about better help. But I had been interested in therapy so I tried to find a therapist from a local person instead. Found out my bill was nearly $200 a session. And since therapy isn’t something like an annual doctor visit or a twice a year dentist visit, I noped out of that.
So I more than understand why people choose Better Help. It’s often actually affordable.
You nailed it. 💯
This is very accurate. I worked 5 years in a BH Insurance company. We saw shitty providers all the time, and we were constantly having to play the game of deciding how much we (and our members) could tolerate before cutting the providers out of the network. Cutting too many providers doesn’t correct bad actors or replace providers for people who need them and can cause backlogs if other providers aren’t available to take on their patients.
The only thing we were able to do to correct many providers by changing their pay to a value based model, so providers would get paid more for better outcomes (and sometimes only paid when patients improve). It would increase pay a lot over standard rates. But providers fought that big time. They just wanted to do things their way and cash a check of a set amount with little or no oversight.
Better help is used by providers as a way to supplement their income, and they typically pay a bit less than conventional appointments because of the digital channels. However, Ive heard they have some issues with data security on their platform and their matching system is pretty flawed due to their network being somewhat ephemeral.
If you do want to seek therapy, remember you have multiple ways to get it covered. Your health insurance probably has some coverage, and your employer (in the US) likely has an EAP program which will have coverage for therapy for at least a few sessions (typically 3-12) sessions. It’s worth looking into that before paying out of pocket.
I have lifelong major depression, and got myself integrated into the mental health system of San Francisco (one of the better municipal systems available in the States). Since my insurance was government or state, it typically meant that I’d see interns for a year before they graduated and started their own practice. A friend of mine and I would joke that we were trainers in that our life drama was severe enough to convey to our trainees that life shit is real and that sometimes there are real risks (suicide, stalkers, toxic violent parents, etc.) but we personally were not likely to become a danger to ourselves or others short of natural disasters.
I also got to crush egos because it’s not like the movies where the patient has a good cry and then is better. I’ve done a lot of crying and I’m still depressed as ever (more so as the world is literally burning, which limits my hope for a better future). I can manage my symptoms more or less, but I’m never going to be a happy self-sustaining good little citizen. And curiously, some of them see that as an end goal: You get Will Hunting to have a good cry and he’s fixed. Not so much.
I eventually got lucky, and was able to find one of my old interns and resume with her while she was working on her PHD. I was a case in her thesis and got an ASD diagnosis out of it in my late forties (it’s not helpful yet for navigating benefits, but is useful regarding directing my own symptom management). But most of my career as a patient is spending more than half a year getting my therapist familiar with my case and then the remaining months squeezing a bit of process out of it…
…Or just goofing off, since I absolutely have personal demons that don’t want to be closely scrutinized, so it becomes too tempting to let my therapist get distracted by details that are entertaining to them. (My history in the BDSM and my burgeoning queerness are fun topics, as are my awareness of issues like the climate crisis, the plastic crisis, the police state, the surveillance state, the transnational white power movement and its uprising and takeover – all of which were still commonly regarded as conspiracy theories / fringe hypotheses when I was in session.) Sometimes, we patients are so terrified of what our closeted shit says about us that we’re not ready to open those doors. And sometimes the therapist doesn’t want to look either, so we negotiate a diversion we can agree to distract us until later.
I stopped going to therapy shortly before the COVID-19 epidemic outbreak and lockdown so I get to start all over again in Sacramento. Hopefully, I’ll find a permanent therapist (and a good match) early, but I suspect I’ll be back to seeing interns again.