In Defense of Psychotherapy

October 7, 2018

This essay shares my feelings exactly.   Written by Dr. Ashley Boswell Baker, psychologist, for her local newspaper in light of the recent testing code changes that take place Jan 1st.  Shared with permission. 

In defense of psychotherapy:

Tv and movies get my job wrong. I’m not Dr. Melfi or Harley Quinn although I like them both. But reality is less interesting. My clients aren’t mob bosses or jailed psychopaths; they are your neighbor, your boss, or your child. I’m not telepathic, I rarely analyze when I’m off the clock, and I enjoy the quiet life- books, my family, and my fledging garden.

But I am significant in a way. I’m a container for peoples secrets, of “the shadow” if you are a follower of Carl Jung. We all have our vices, what’s helpful about psychologists is we talk about yours out loud. The thing you’ve been hiding? I want to know about. The thing that breaks your heart? I’m interested in that too. And I’m fully there, in my office, I am 100 percent rapt to every word you say, every gesture, the way you sit, the way you hold your hands. Humans are unique as mammals in that we care about others and the impact our behavior has on ourselves and our loved ones. Most apex predators don’t, and psychologists by nature are very curious but private people. Counselors fall under privileged communication as do your spouse,
priest, and attorney. Usually though the spouse will rat you out first and then your attorney, which leaves the therapist and priest standing still and silent, holding your truths for you until you’re ready to say them yourself.

It’s took me six years after college to get my doctorate. I’ve seen every symptom, and witnessed multiple version of the DSM, our diagnostic manual. I’ve been in practice for almost ten years. I’ve never driven a Jag or had a skyline view. I don’t know any shrinks who are rich. It usually conflicts with our views- we want to help people, all people. Most of us want to leave the world a better place than when we found it. So to reach the most people, we take insurance. And this is a battle we are fighting and losing; we have sustained so many losses that most of us get weary and drop out of networks. But how can you be a social justice warrior when most of your clients can’t afford ya?

I can’t see fifteen patients in an hour like your pediatrician, I can only see one. That is, until United Healthcare said I can’t do hourly sessions anymore, only 45 minutes. BCBS followed suit in a callous way, they said if you do hourly sessions we will audit you and check your records for any mistakes. I held strong. I’ve been audited three times. I passed but I killed many trees and spent numerous unpaid hours faxing information to be reviewed by someone with a different degree than me. We are in network but we have no control of when we get of if we get paid. You got a problem with a claim? Be prepared to wait an hour on hold only to get hung up on accidentally. Be prepared to be told, “oh you should have said “suite” and not the abbreviation “ste” on the address form. Resubmit and it takes up to 90 days to pay you, sorry!” Or the highest point on the offensive triangle—legitimate disorders like ADHD or Autism “aren’t covered by this patients plan, they are exclusions.” How can that be? They didn’t cause it. But you know what the insurance company line is? Your child with a speech delay, who has special needs and is nonverbal, he has a BEHAVIOR disorder meaning that if he just tried hard enough he could change himself into not having Autism.

Now you know just what we are up against. It’s takes a certain kind of venomous creature to deny help for struggling kids but just ask the behavioral health CEO of Amerigroup what told me Psychological testing is an archaic practice. I guess I spent my life pursing the wrong thing; wish I had known at 21 when I entered graduate school that I’d be obsolete in my 30s.

Because honestly there’s a pill for that.
Big pharmaceutical companies market new versions of the same old drugs because who really cares about the difference between ADHD and a learning disorder? Or bipolar disorder versus borderline personality disorders versus a sleep disorder? Won’t Ritalin fix it all anyway? And it will- maybe- for a little while. Until the next crisis happens and people says it’s a mental health issue- let’s reform mental health! Do you know my contracted rate with Humana got slashed by 50 percent overnight ? I woke up one morning to a huge pay cut. Do you know our own organization, the APA, helped insurance companies change our codes from one code per service to 17 different codes? And that’s the people we pay dues to speak for us.

We are in a mental health crisis. People are sicker than ever. They are anxious and they are scared. But you know what? There’s no diagnosis code for ubiquitous fear and even if there was, your insurance wouldn’t cover it anyways. They will cut our rates without saying a word. They just let us know about the recent code changes in an email newsletter. What other profession can you wake up to see your salary in shreds? They require preauthorization on everything and then turn around and deny it completely.

Pretty soon there will be none of us left. Besides professors, we are the most stringent and educated profession that works for pennies on the dollar, so much so that one of the smartest people I’ve known in my life left the profession entirely because they didn’t know her worth. She couldn’t survive on what she was paid. And we will never ever make what we deserve because it’s a question of value. In a world of instant fixes, plain old therapy can’t evolve. We were never meant to, we believed as long as people had relationships there would be a need for us. There’s still a need but no one to fund it.

We are outnumbered. The last stand is on the horizon, where enough of us will drop all insurances forever, and treat only those who can afford our fee. They’ve left us no choice, I lose money on my private practice when insurance denials cause costs to outweigh the net profit.

But hear my battle cry. We’ve been fighting for the child with Medicaid to get an IEP or the kid with psychosis symptoms to get an MRI and no one even knows about it. Our clients are always on our minds; we are the first to wake up and the last to leave. My three year old thinks it’s normal for mommy to read textbooks in the car on road trips so he told his sister that when she can drive he can ride shotgun so he can “work in the car.”

I wrote this to tell you I’m not going down without a fight. Forget about me and my car with the broken tail light that hasn’t been fixed. Forget about the long reports I write that I’ll never get paid for and MD’s don’t read. I got into this profession because I care deeply, and because I believe people can change. I believe no matter what you’ve done or what your diagnosis is, you can get better. I believe in Hope. I believe in my patients. I believe pills have their limits. And I believe Desmond Tutu when he says “If you are neutral in situations of injustice, you have chosen the side of the oppressor.” As long as I have a voice, even if it shakes, I will say what the insurance companies are doing to me, to you, to everyone with regards to mental health is a travesty and a threat to our nation and our children. I will continue to say it until someone, until anyone, listens to me. 

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