June was a crazy month, or at least it was a month when I felt pretty crazy. Alison and I had planned a 10 day road trip to spend time visiting family, but I ended up spending an extra eight days out there when some family members asked for my help. If my people need me I’m there!
During the planned parts of our road trip we (me, Alison, and my mother in law) visited three cities and found some drama in each location ranging from minor to serious. Every family has its drama! I can’t control what other people decide for their own lives, so I have to trust that the grownups in my life can decide what’s best for them. And the good news is that the dog’s health improved, the air conditioner was fixed, the aunt decided where to live during her elder years, and we were able to go home to focus on ourselves. And the best news was that despite the drama we had some really good times along the way with friends and family, especially our nieces and nephews. But I tend to absorb drama and emotions from other people so I carried anxiety, sadness, anger, and guilt home with me.
While we were in the middle of the most stressful part of that trip there was another bonus. An old college friend of Alison’s just happened to be passing through town and instead of a lighthearted discussion we got into some really deep conversations. Before we all went our separate ways they gave us a book recommendation, “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk. The science of mental health and traumatic stress are fascinating subjects. Since early June when we got this recommendation Alison and I have both already read this book twice and we’re still talking about it with friends and family.
At the end of our trip I dropped Alison off at the airport at 4:30 am in Phoenix to catch a 6:00 AM flight. I was looking forward to some alone time while Alison was gone helping our housemate drive a U-Haul back to our compound from a few states away. But literally 10 minutes after I got home I received a “prepare to evacuate” order by text because of forest fires in our area. That didn’t make it as easy for me to relax as I had hoped, but I was grateful that I didn’t actually have to evacuate. And I was able to enjoy some peace and quiet once I got the car re-packed and ready to go with all of our important documents, just in case. I spent two nights alone before Alison and our housemate arrived, and that little bit of solitude allowed me to start processing the previous few weeks, and continue processing old childhood memories as well.
Time for More Therapy
Even before I got home from that trip I decided I was ready to get back into counseling, and I was surprised to realize it had been around 17 years since I last worked with a psychologist. Life is good when you’re in a healthy, loving primary relationship!
The last time I was in counseling was after my last relationship ended way back in 2004. My therapist at the time did a great job of helping me learn from that toxic relationship. She helped me look at the underlying patterns of my behavior so I could understand how and why I was in such a toxic relationship in the first place. And it’s not a coincidence that when I met Alison in Seattle back then we were both seeing our own therapists, each working on ourselves in hopes of being ready for a healthy relationship when the time was right.
My Grandma took me to my first therapist when I was a kid to help me cope with the neglect and abuse I had experienced from my mom. It had become clear that I was seriously depressed, and that first experience with regular therapy sessions made a big difference in my life. After that my Grandma took me to see my second childhood counselor and that one tried to facilitate a reconciliation between me and my mom, which was unsuccessful to say the least. But those early experiences normalized the idea of counseling for me and that made it easy for me to seek therapy as an adult whenever I was experiencing extreme stress. Thank you for yet another excellent life lesson Grandma!
Regular counseling was pretty normal for me when I was in my teens and 20’s, and I can remember talking to various counselors about all of my closest family members, how I struggled in school, work stress, financial stress, and relationship stress. Those counseling experiences were a long time ago but the lessons I learned definitely helped me keep growing and changing.
Adding a New Money Job to Our Budget
This is the first time Alison and I have had a line item for counseling services in our budget, and that’s crazy (hahahaha)! It’s clearly time to make an adjustment. We are proud personal finance nerds so we agreed that we needed a new Money Job in our budget specifically for mental health counseling which fits with every other health related Money Job we fund like health insurance premiums, dental work, and eyeglasses. Calculating the cost of counseling services was tricky since I can’t predict how long my therapy needs to last this time, but whether I hit this financial target or not the exercise of tuning into the cost of mental health care was very useful.
The first thing to think about when setting this budget was my motivation for seeking counseling, and that was one specific crisis during our road trip. That crisis had a clear start and end, and it really wasn’t about me specifically. But it was a crisis that resurrected my childhood trauma, and those old family issues were the real reason for me to get back into counseling. I have already addressed my issues with previous counselors and I do feel healthy personally. But my old issues are serious enough that they don’t go away completely, which means I need to keep addressing them whenever old demons haunt me.
Since I haven’t paid for counseling in many years I did some research and found a range of $100-$200 per hour in the USA. That price range is wide because there are different types of counseling services and sometimes those prices are also impacted by the cost of living in specific locations.
With a short term crisis and an epicenter outside of my life as my reason for therapy this time, rather than an ongoing personal crisis happening directly to me, I decided to budget for weekly counseling at $150 per week for 16 weeks, which is $2,400. That might be an initial number that we need to add to, or it might be the right annual budget for one person to keep using in the future. Once I had a first guess at a Mental Health Money Job I felt like I had something carved out just for me, and there was no reason for me to stress about the cost of counseling.
Comparing Costs With Friends
I checked in with a friend that we talk with a lot about mental health related topics, and she said her therapist in California quoted $200 per hour, but our friend negotiated that down to $125 per hour. Wow! Then I asked a friend in our previous home town back in Washington State for some feedback and she quoted $175 per hour, and I assumed I would pay something pretty close to that price. Then I got even more curious and started checking with friends outside of the USA to find out what they pay for counseling in their locations.
England: A friend who started counseling in London in 2019 found a therapist who quoted £50 GBP per hour (around $69 USD), but asked for a reduced rate since he had a low income and they agreed to £40 GBP per hour (around $55 USD). He’s actually still paying that same counselor that same weekly fee to this day. Another friend down south in England said he could get free sessions through the National Health Service (NHS) if he had a diagnosed mental condition, but he doesn’t have a diagnosis and receiving counseling through that system could take months. Another friend who’s from a borough in northern England said she was paying £60 GBP per hour (around $83 USD) for counseling.
Canada: A friend in the province of Alberta told me she would expect to pay around $100 CAD per hour (around $80 USD) for counseling. She also mentioned that most employed people in Canada receive supplemental health care which would typically cover all costs for four counseling sessions per year, similar to what they are allowed for other therapies like physical therapy, chiropractic therapy, massage therapy, speech therapy, etc. Another friend in the province of Nova Scotia told me they would have to pay $200 CAD per hour (around $160 USD) for counseling, but they have very limited resources in the area so it could take months of waiting for an hour of counseling.
Australia: A friend in the state of Queensland said she would likely pay $60 AUD per hour (around $40 USD) out of pocket for therapy, while another friend in the state of Victoria said she would have to pay closer to $100 AUD per session (around $73 USD) where she lives.
Poland: And then a friend in Poland told me that counseling services cost 160 PLN per hour (around $41 USD) in his home state of Warsaw.
Admittedly, I assumed counseling costs would be grossly more expensive in the USA compared to other locations, and for the most part that was true. I also assumed counseling would be covered by national health care in other countries, which was not as true as I had expected/hoped. The most interesting feedback I got was from people who said seeking counseling in their countries and cultures was so unusual that they hadn’t tried counseling and didn’t know of anyone else who had either, so they couldn’t even estimate what it would cost. And that reminded me that my mother in law told me when she was young it was very taboo to talk about counseling services. She really didn’t know anyone who worked with a therapist when she was young, even if they had serious issues impacting their lives and their mental health. Those old taboos about mental health are a still a problem all over the world!
Finding a Therapist
Every location (hopefully) has its own mental health resources and they aren’t always equal in function or availability. Some locations are flush with options while others have slim services available. I was confident I could find a good psychologist in my local community and I looked forward to comparing that with at least one of the online resources for mental health services that became more widely available as the Covid pandemic started to spread around the world.
I was curious about BetterHelp since I kept hearing about their services while listening to podcasts. The Covid pandemic really had an impact on me and at this point I would prefer not to sit in a small room every week with someone who isn’t part of my household. I really loved that BetterHelp would make it easy for me to get paired with a counselor who specialized in supporting LGBTQ+ clients. I shouldn’t have to waste any time or money trying to define my queerness to my therapist (yes that is a real issue for LGBTQ+ people and something I experienced in the past). I also liked that BetterHelp is “reasonably priced” at $95 per week compared to other options in an expensive industry. But I didn’t like that their price structure is designed to be weekly, even if you don’t use their services every week. Maybe I’m old fashioned when it comes to mental health services, but I like paying by the hour.
In the past I’ve always paid for counseling services out of pocket so I was very curious about using our insurance this time. I searched for mental health services through our insurance portal and found a few counselors close by that worked within our network. There was one group office that looked promising since they had a few psychologists flagged as accepting new patients, but they all seemed to specialize in areas that didn’t fit me. One specialized in new mothers, another specialized in children, and a third specialized in couples counseling. None of those options were a good fit for me.
I kept scrolling though the list of counselors in my insurance network and found a private practice offering virtual appointments. Her virtual meeting system was not a result of the Covid pandemic, she had been practicing with only virtual appointments for years. Awesome! And She was flagged as specializing in treating women and LGBTQ+ clients. That’s me! There’s so much value in being able to see yourself in your doctors, whether they’re primary care providers or cardiologists or psychologists. It’s really important for people to feel seen, heard, safe, and understood as patients.
I did more research on that psychologist including on Psychology Today (which supports mental health services in a variety of countries), and bingo! I found my new therapist, and I sent her an introductory email immediately. Her out of pocket cost for individual therapy was listed as $180 per hour on her website. And it looked like my insurance would cover at least some of those costs.
We have Affordable Care Act (ACA) marketplace Blue Cross insurance and we’re benefiting from President Biden’s American Rescue Plan (ARP). The ARP expanded ACA premium subsidies and also modified the rules for year-end tax reconciliation of subsidies for 2021 and 2022. Hopefully those affordability changes will be made permanent and the next round of ACA improvements is also on its way. But thanks to the ARP our monthly premiums dropped from $144.71 per month to ZERO and we stopped paying premiums after April. We’re getting eight months of premiums for free in 2021, which will save us $1,157.68 this year alone.
During my initial chat with my new therapist she explained that she recently decided to stop working with insurance in her practice. By October her insurance connections would be severed and we discussed that at length. I was fascinated to hear how complicated it was for her (and probably lots of other psychologists) to work within the insurance industry. First of all, in order to qualify for insurance coverage the system requires a mental health diagnosis such as adjustment disorder, eating disorders, a substance abuse disorder, or a factitious disorder, just to name a few.
I see this as a major flaw in the health care industry. I am allowed to use my insurance to see my primary care provider (PCP) simply because I don’t feel good, but I can’t use my insurance to see a mental health counselor just because I don’t feel good. That difference doesn’t make any logical sense.
My insurance company also requires a referral from my PCP. The referral requirement could be problematic since people tend to reach out to counselors for help when they’re in a crisis, and it would be ridiculous to put a crisis on hold while you wait for a referral and a diagnosis from a PCP. When I decided to seek counseling I got lucky because coincidentally I had scheduled an appointment with my PCP a month before I went on that June road trip to see family, and I just happened to have an appointment with my PCP a few days after I got home. I went in for an annual exam and came home with a referral to see the specific psychologist I wanted to work with, and a diagnosis of “F43.20 – Adjustment Disorder.” My PCP chose that diagnosis because I was literally struggling with adjustment issues relating to that crisis I got wrapped up in during our road trip. And then I had my first session with my new therapist the day after I saw my PCP.
What does that diagnosis mean? From what I’ve been told, Adjustment Disorder is “mental health diagnosis lite.” It sounds like anyone with major life stressors, who has anxiety or depression as a result of those life stressors, could probably qualify for an Adjustment Disorder diagnosis. Of course in some cases Adjustment Disorder is pervasive and intractable and definitely not a lite diagnosis to live with, and in those cases it could precede a more specific diagnosis. But many high functioning counseling patients like me qualify for an Adjustment Disorder diagnosis.
My psychologist explained that for insurance purposes my diagnosis is intended to focus on a particular crisis or distress scenario that is relatively short term. She also told me that my Adjustment Disorder diagnosis can only stay in place with my insurance for 90 days, and in order to continue using insurance for therapy beyond that timeframe I would need a new diagnosis. But since my psychologist won’t be attached to the insurance industry beyond the next few months I’m not concerned about that timeline.
The other issue I have with using insurance is their requirement for doctor’s notes after each counseling session. I guess that shouldn’t have surprised me since my PCP is also required to submit notes to my insurance company after my appointments, but her notes include details like my weight and blood pressure which I don’t take personally. It feels much more invasive that my psychologist has to submit notes to the insurance company after our sessions. But she explained that she’s not willing to submit detailed notes about her clients to the insurance company (thank goodness), which is part of the reason why she’s severing ties with insurance. She keeps two sets of notes, one set is very detailed and for her eyes only to support our discussions. The other set of notes is extremely brief and mostly repeats the current diagnosis for the insurance company. I don’t mind the insurance company getting a report of how many stitches I get if I cut myself, but they don’t need exact measurements of my emotional scars. Insurance companies should not have access to my personal thoughts and feelings, or descriptions of my memories, or detailed descriptions of my traumatic experiences.
For me counseling is about actively becoming more aware, mindful, and conscious of my self and my behavior. I’m keeping a journal with notes about everything I’m learning and how well my treatment plan is working. And working on that journal every day is what inspired me to write this post.
My new psychologist is awesome, and she totally gets me. We talk a lot about the survival skills I started using as a little kid when my mom’s neglect and abuse were present in every moment of my life. I don’t think they improved things even back then, but the assumption is that those survival skills actually did help me survive. Unfortunately those demons all come back when I’m stressed, so I keep using those old survival skills even though they’re more harmful than helpful. That’s exactly why I’m in therapy.
Depending on the situation there are some relatively common survival skills that people use when severely stressed. They can include dissociation, germaphobia, panic, acute emotional outbursts, immobility, indecision, codependency, and extreme control issues. My new psychologist and I talk a lot about how I use my stress behaviors and the negative impacts they can make. I want to change my behaviors, and I want to have control over my emotional wellbeing. I’m very open to all of the hard work this process is taking, and I’m actually enjoying myself through most of it. And when it’s hardest and I feel emotionally exhausted I give myself the space I need to recover. I am trying and I am learning a lot.
The Alcohol Elephant in the Room
I’m very aware that both of my biological grandfathers were alcoholics. My maternal grandfather had pretty much stopped drinking by the time I was in the picture (which doesn’t erase the fact that he was a serious alcoholic). But my paternal grandfather never stopped drinking and he actually died from his alcoholism at the very young age of 42. My grandfathers both had severe PTSD from their military service during World War II, and they both became alcoholics because they weren’t able to cope with their PTSD. It doesn’t sound like either of them enjoyed alcohol, but they weren’t presented with any other option to cope with their mental health issues so I can understand how the pain and suffering they each experienced during World War II, compounded with the challenges they experienced in their youth and in their adult relationships, would have set them on the path to depression and addiction.
One generation later both of my parents started drinking and doing drugs when they were young. They both started drinking in junior high school and they both were doing a lot of drugs and drinking heavily by the time they were in high school. They definitely enjoyed alcohol and drugs, and their substance abuse issues fit nicely with all of their other toxic and abusive behaviors. My dad never stopped drinking and eventually died of liver cirrhosis. My mom did stop drinking, and she is a Dry Alcoholic at this point in her life. But the fact that she stopped drinking did nothing to improve her behavior. Dry Alcoholics aren’t necessarily easier to cope with than Alcoholics. My mom is still the same narcissistic, uncaring person she was when I was a kid which is why I protect my own mental health by making sure my mom has no involvement in my life.
Honestly there wasn’t much to do other than drink and do drugs in the small town we all grew up in, and that definitely contributed to substance abuse issues for many of my family members and peers starting in junior high school and high school. That doesn’t mean every kid in town was drinking and doing drugs but it was common for a lot of kids where I grew up. I feel lucky that I didn’t get into drugs or alcohol as a kid myself. Research has shown that the majority of alcohol or drug addicted adults in the USA started using substances when they were kids. That shouldn’t surprise anyone. I know people who had their first experience with cocaine, or their first drink of whiskey, or their first hit of heroine when they were kids, or all of the above. And they all became substance abusers as adults. I am not here to judge anyone. But I’m very glad that I’ve never had anything like cocaine or heroine in my body, and I don’t have a problem with alcohol. The last thing I need are substance abuse issues in my life.
Since I have so many examples of substance abuse in my family, a lot more than I’m mentioning in this post, I keep a really close eye on my own behavior. And I do worry that I’ll go down that same path myself. The behaviors I keep an eye out for specifically include drinking alcohol in the morning, drinking alcohol throughout the entire day, sneaking alcohol from the bottle when no one’s looking, hiding alcohol around the house, and lying about how much or how often you’re drinking. Those are the behaviors that scare me the most. Those are the behaviors I can’t tolerate in others or in my life in any way. And those are the behaviors I never want to see in myself. I know if I start exhibiting those types of substance abuse behaviors I would be risking my life and my relationship with Alison.
Adult Children of Alcoholics
In June when things were chaotic a few of my close family members recommended that I consider joining an Al-Anon group along with my weekly therapy sessions. I’ve heard a lot about Alcoholics Anonymous and Al-Anon over the years and I was curious about what that type of group meeting would feel like for me. To be honest I was assuming Al-Anon would seem goofy, overly religious, and unappealing for me personally but I still wanted to give it a try.
Al-Anon is a system of communities for Adult Children of Alcoholics like me, and anyone else who worries about people they love that have substance abuse problems and/or other types of addictions. Participating in Al-Anon is a way to connect with other people who have faced similar issues and a way to find strength and hope.
I looked online and found Al-Anon groups in every location I could think of, all over the world. I picked a group that isn’t in my new home town or even in my home state, but this group seemed like a good fit for me. And since I’m only interested in virtual meetings I chose a group that has weekly meetings using zoom.
During my first meeting what stuck out for me was how much time someone was reading passages aloud from a book. They started and ended the hour by reading their rules aloud and there were other passages read from books throughout the meeting as well. When it was over I wasn’t sure I wanted to attend a second meeting, but Alison encouraged me to stick with it for at least a month.
During my second weekly meeting I wasn’t as distracted by the readings because I had become interested in the people in the group. I heard so many stories that night about how much my group members have struggled with the same issues I struggle with, like codependency and control in the face of their family members’ unhealthy behaviors. Everyone who spoke that night talked about their ongoing efforts to let go of things they can’t control, which was just what I needed to hear. No matter how different those other people were from me, their stories and their concerns sounded very familiar.
By my third weekly meeting I was hooked. I asked for a sponsor and shared my story with her, and she shared her story with me. My sponsor made it clear that their Al-Anon group functions as a chosen family, and I could see that. Everyone in the group has made an effort to make me feel welcome and to encourage me to keep coming back, and I really appreciate that. My plan is to stick with this Al-Anon group for at least as long as I’m in counseling, because it’s clear these two therapeutic activities work really well together.
My biggest challenge with Al-Anon is the religious terminology in their books and in their processes. But the rules they read aloud in every meeting remind us that Al-Anon is not part of any religion. My sponsor told me whenever I come across the word “God” in the readings I should replace that word with something I’m comfortable with, like “nature” or “universe,” or whatever floats my boat.
There are no fees for Al-Anon meetings. My group takes voluntary contributions and members donate what they can. My sponsor said that $3 per week is a typical donation, and I’ve decided to donate at least $5 per week.
The group’s expenses include meeting room costs, books to give to participants who can’t afford to buy them, books to sell to participants who can afford them, and the microphone they bought so those of us on zoom can hear the group more clearly. There are a ton of books written for Al-Anon members so my sponsor did a little show and tell of all of the books on her shelf relating to Al-Anon, and then helped me pick one to start with. I chose “How Al-Anon Works for Families & Friends of Alcoholics” as my first book and I’m reading it now, over and over and over. Once I felt ready for a second Al-Anon book I chose, “Trauma and the 12 Steps, Revised and Expanded: An Inclusive Guide to Enhancing Recovery” by Jamie March.
My sponsor is a wonderful woman and I would have thought we had nothing in common if I had met her through different circumstances. But we have a lot in common because we both have family members with substance abuse issues, and we share much more than that. The way this woman spends her time and money supporting others in Al-Anon reminds me of the way Alison and I spend our time and money supporting other people with financial coaching. My Al-Anon sponsor is inspiring the hell out of me!
Tracking My Mental Health Spending
I’m glad we’ve added a mental health Money Job to our budget this year, even though I still can’t say for sure how much I’ll need to spend. But I can say for sure that we’ll keep at least that much money set in our budget for counseling and related costs from now on. Worth It? Hell yes!
That’s My Plan for Now
I’m really glad to be in weekly counseling. And I’m really glad to be in weekly Al-Anon meetings, along with weekly video chats with my sponsor.
Change is hard. But I’m lucky to have more than enough time and energy available to work on this stuff at this point in my life. I am trying and I am learning a lot.
I would be tempted to say I should have tried Al-Anon groups before now, but I know I would not have been ready for Al-Anon before this recent crisis motivated me to get involved. You have to be emotionally ready to do the hard work it takes to succeed in order for things like individual counseling or group therapy to work. If you think Al-Anon might be helpful for you I would definitely recommend that you give it a try.
I’m a huge believer in seeking counseling whenever there’s a crisis in my life. And though my issues are unique, the fact that I’m benefiting from counseling is definitely not unique. Everyone is different but the important thing to remember is that whatever stressors you’re dealing with, you are not alone, and a qualified licensed professional counselor might be able to help you rebalance and maintain your mental and physical health.
When you’re feeling stressed, remember to breathe…
If you need help, here are some options…
The BetterHelp website includes this list of helplines that is far more diverse and comprehensive than any other list I’ve been able to find or compile on my own. If you need help please give at least one of these helplines a try.
- Emergency: 911
- National Domestic Violence Hotline: 1- 800-799-7233
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- National Hopeline Network: 1-800-SUICIDE (800-784-2433)
- Crisis Text Line: Text “DESERVE” TO 741-741
- Lifeline Crisis Chat (Online live messaging): https://suicidepreventionlifeline.org/chat/
- Self-Harm Hotline: 1-800-DONT CUT (1-800-366-8288)
- Essential local and community services: 211, https://www.211.org/
- Planned Parenthood Hotline: 1-800-230-PLAN (7526)
- American Association of Poison Control Centers: 1-800-222-1222
- National Council on Alcoholism & Drug Dependency Hope Line: 1-800-622-2255
- National Crisis Line – Anorexia and Bulimia: 1-800-233-4357
- GLBT Hotline: 1-888-843-4564
- TREVOR Crisis Hotline: 1-866-488-7386
- AIDS Crisis Line: 1-800-221-7044
- Veterans Crisis Line: https://www.veteranscrisisline.net
- TransLifeline: https://www.translifeline.org – 877-565-8860
- Suicide Prevention Wiki: http://suicideprevention.wikia.com
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