For adoptive parents, discussing adoption with their children is a lifelong conversation starting (hopefully) as soon as they arrive to the family and continuing on for the rest of their lives.
It can be difficult to know how to share, what to share and when to share particularly as our children grown and their developmental, emotional and practical needs change. When do we tell them difficult details about their origins? How do we support their need for connection or their need to push away? How can we anticipate what they are likely to need from us as they grow into teens and then into adulthood?
In February, I’ll be offering my Talking to Kids About Adoption workshop as support for adoptive parents who are trying to figure it all out. You can learn more about it and register here. I’ve also been invited to write about the topic at the Adoption Circle web site and you can see the first in that series by going here.
We will do a quick overview of the research and discuss recommended best practices and there will be lots of time to ask questions so we can address the particulars of your family’s situation and your child’s history. I’ll also share a list of resources so families can move forward on their own after the workshop.
Because there’s tremendous need for this support, I will continue to offer this workshop regularly. If you want to stay up to date on the speakers, workshops, classes and groups that I have upcoming, be sure to sign up for the newsletter by filling out the form below.
There’s no getting around the fact that therapy can be expensive. Sure, you may pay less than you would for a hair cut and color or just a little more than you would for a massage, but most people don’t get their hair cut as often as they’re likely to go to therapy. I mean a dye job lasts what, six weeks? And most people see their counselors about four times a month.
The reasons therapy costs so much are:
- Schooling. In order to offer psychotherapy, your counselor needs an advanced graduate degree. Generally Counselors, marriage & family therapists and social workers need a masters and psychologists need a PhD.
- Licensing fees. Ongoing expenses include paying for our license and certifications as well as our professional memberships in organizations like the American Counseling Association or the National Association of Social Workers.
- Continuing education. Therapists need to have continued training to be sure we’re up on the latest research and that we’re staying abreast of what our professional ethics and the law require of us. States vary in their demands and the costs of training differs a lot, too, but most of us sink a few hundred a year into making sure we’re up to date. If we have other certifications — in, for example, hypnotherapy — we will need to take classes to maintain that certification, too.
- Insurance. We pay for professional liability insurance the same way that doctors do (fortunately our costs are a lot less). Most of us need the insurance to maintain our licenses.
- Rent and utilities. Even if we’re not in practice for ourselves, part of our income goes to keeping the office open and the lights on. Bigger cities, naturally, charge bigger rents and thus more expensive therapy. For those of us in private practice, rent is likely our biggest expense (I know it’s mine).
- Phones. Some therapists also pay for an answering service.
- The cost of doing paperwork. Those of us who take insurance (I do not) generally negotiate rates with each contracted insurance company. So you pay your co-pay and the clinician bills the insurance company for the rest of the rate initially agreed upon (and this is usually something the insurance company dictates; therapists can either agree or not). The paperwork required for insurance eats up a lot of time. Insurance companies differ in what they require and when and keeping track of it, submitting the billing, following up on payment (because insurance companies don’t always pay in a timely manner) and going back to the client if there’s something sticky takes up a great deal of office time, which could go to seeing clients so therapists bundle that time into their fees. Some of us farm these tasks out and pay a biller, which also obviously adds to the cost of therapy. For those of us who don’t take insurance, the paperwork demands are a lot less but ethically and legally we are required to keep certain documentation up-to-date. After a session with a client, we have to write up the session and again, our pay for this is bundled into the fee we charge the client. Note: Those of us who take insurance generally charge more than those of us who don’t because of the cost of doing business with the insurance company but most of us end up making about the same amount. People who take insurance spend more time on maintaining paperwork and those of us who don’t spend more time on marketing (since insurance companies do much of the marketing for you, giving your information to consumers who use their plan). A full-time therapist (i.e., someone who works a 40-hour week) isn’t seeing clients for all of those forty hours. Some of those hours are doing paperwork, getting training, meeting with supervisors or getting peer support, marketing, talking to insurance companies, printing out worksheets for the next session, reading research, calling to coordinate care with other providers, following up with clients who missed appointments or have questions or emergencies; etc.. Client fees have to also cover the invisible work of being a therapist.
- Miscellaneous supplies and fees. Therapist need to print out worksheets and forms, keep our furniture in reasonably good shape (and replace broken down chairs and sofas), maintain a working supply of pens and paper, and Kleenex. Most of us also need to pay for a web site and/or for inclusion in membership directories so clients know how to find us. If we work with kids, toys and art supplies need to be available and in good repair. Then of course there’s stuff like bank fees, the cut the credit card company takes, etc.
After all of these expenses are taken from our hourly rate the rest goes toward our salary. Part-time and contract workers at agencies and practices as well as those in private practice for themselves also have to pay taxes (about a third of their income), health insurance and retirement (not to mention banking for sick or vacation days) out of that what they take in.
And that’s why therapy costs so darn much.
There are options to make therapy more affordable:
- Use your insurance. Not all insurance plans offers mental health benefits and not all insurance plans that do make it more affordable. (Plans with high deductibles may take a lot of time and money before you see any savings.) You will need to find a therapist who takes your insurance and then you will need to receive a mental health diagnosis that your insurance company will cover. Once you get that diagnosis, your insurance company will need to approve the treatment plan your therapist gives. All of this sounds very complicated but therapists who take insurance generally understand how to make it work for you. Make sure you are clear about what the diagnosis and treatment plan mean and what exactly will become part of your health record. Also note that most insurance plans do not cover couple or family counseling and may not cover certain diagnoses. Sometimes you won’t find this out until your bill gets denied so take some time to make sure it all makes sense to you and your therapist.
- Use your Health Savings or Health Spending Account. If you have a HSA card, see if it will cover counseling and if your therapist is able to charge HSA cards. Most of the time these plans will only need you to submit a monthly or quarterly receipt but check first to see.
- Seek out a practice or agency that uses a sliding scale. Sliding scales tend to be needs based and different therapists and practices require different documentation; some will want proof of income and others will not. Not all therapists will advertise their sliding scale so if there’s someone you’d really like to see and you’re not sure if a sliding scale is available, call and ask.
- Explore group therapy. Groups tend to be much less expensive than individual therapy (that’s one reason I decided to create the Parenting Challenging Children group — it’s a more affordable way for parents to get help) and research shows they can be be just as effective. I especially like groups because I feel that community can be incredibly healing for those of us who feel isolated in our struggles.
- Seek out a publicly funded agency since they often have more generous sliding scales. Depending on your income, using a county agency (in Central Ohio those are agencies funded by the ADAMH board, a list of which you can find here) may allow you to pay very little and sometimes nothing for counseling. Because they receive outside grants to fund mental health support for underserved clients they can subsidize their services. There may be a wait list and depending on where you live, it may be long but check in regularly since cancellations do happen and sometimes the intake person can get you in more quickly than originally promised. (Sometimes if you call in the morning they may have a last minute slot open up in the afternoon.)
- See your therapist less often. While meeting every week may be ideal (it’s easier to create and stick to change when you can devote an hour each week to working on it), you can go every other week or even less often if your therapist agrees.
- See an intern at the practice. Not all agencies or practices hire interns but those that do sometimes charge less since those practitioners have less experience. Interns are supervised by other counselors with specialized supervisory training although what this means will depend on the practice. If you’re using this option, ask them what this will mean exactly so you know what you’re agreeing to. (Note: Research shows that new therapists can be just as effective as more experienced therapists in part because newbies have lots of enthusiasm, which can make up for their lack of real world experience.)
- Do the work. Counseling is not a race and how long it takes will depend a lot on individual factors but the more energy you put into therapy, the more you’ll get out of it, the more quickly you can create change and the sooner you’ll be leaving therapy. This means showing up for appointments (and avoiding the no-show fees! another way to cut costs), being honest with your therapist and reflecting on what you’ve learned between appointments.
As I replied to Helen’s comment on this post, I don’t like to play with my kids. I like to play with other people’s kids in a structured, time-limited way such as the therapeutic hour because mostly what I’m doing is observing; with my own kids I’m counting down the minutes until I can go read my book. I don’t mind occasional (emphasis on occasional) board games, puzzles, building or other task-oriented play but despite loving to play-pretend as a child, I never really liked to play-pretend with my kids. Oh sure, I’d attend a tea party now and then or “babysit” a doll so they could finish up an adventure but those times were rare, as my kids themselves will tell you.
Their dad is great at it. He’ll get down on the floor and move the little guys around and make the little guys talk to the other little guys but me, I’d rather stay over here with my book, thanks.
I may be lousy at playing but I’m great at talking. Give me a deep discussion or a quick conversation and I’m there. Ask me about sex, drugs, rock and roll and religion and I’m up for it. That’s how I parent — I’m about talking.
Their dad is less great at that. Go ahead, ask him something potentially controversial and watch him change the subject so fast that you’ll be discussing the weather without even realizing how well he’s deflected your question. But he’s got that playing thing down.
My husband is great at some things and I’m great at other things. And you, you’re great at things, too, just not all the things because none of us is great at all the things.
I know a lot of parents feel guilty because they don’t like to play (or paint or cook or whatever) with their kids and I want you to know that I am a licensed expert on this parenting stuff as well as an advocate for less guilt, more joy parenting and I absolve you. You are absolved.
Now your kids still need to play but that doesn’t mean that they need to play with you all of the time. If you like to play then go for it. Do it lots. If not? That’s fine, too.
There are lots of parents who don’t like crafty things (me, I’m raising my hand again) or messy things like fingerpaint or playdough (these I can do). That’s fine. You can farm that stuff out. You can sign them up for a great preschool where they’ll get lots of messy play time or you can look to the library for crafts or you can check out the rec center to see if they offer sewing classes for middle schoolers. You can enlist friends and relatives or ask if anyone knows someone willing to come teach your child archery or Minecraft for cash or barter. You can ask your neighbors if their fourteen year old will come over and talk Pokemon with your obsessed 5-year old while you cook dinner so you can listen to a not-safe-for-children podcast instead.
And you don’t have to play with your kids, or at least not as much as they’d like you to. You will probably have to play some. You will probably have to sip some imaginary coffee they make you or run around the backyard fighting bad guys a little bit but you can say no. You can be not into playing and super into other stuff.
It takes a village, this parenting thing, and the village can cover the things you don’t like to do so that you can really really really enjoy spending time with your child doing the things that you both like.
I’ve been working on revamping my hand-outs and adding a Powerpoint (well, Keynote — same diff as we used to say in the 80s!) for the visual learners. I keep getting asked about offering the class online but haven’t really figured out how to do this. I’m asking some of my colleagues who do webinars about the tech part but I’d also need to figure out how to turn a fairly long class (it’s usually 2-hours across 6 weeks but this time I’m trying 4 hours on 2 days) into something palatable online. Maybe stick with the six week format and hope people are willing to come to their computers that many times? Me, I’m not crazy about webinars so it’s hard for me to figure what others might like. If you have some thoughts, let me know.
Meanwhile if you’re in Central Ohio, come on by this Saturday or sign up for the newsletter (there in the sidebar) and get alerted when I teach the class in the fall (probably in October).
I found this write-up of a study that looked at the impact parenting can have on helping kids cope with depression and anxiety. The study’s authors found that children who were able to regulate their own emotions did better when their parents supported them and gave them room for greater autonomy in managing their emotions. Children who were less able to regulate did better with more support and structuring.
In other words, some kids need more parental guidance and some kids need less.
It’s yet another reason why one-size-fits-all parenting advice doesn’t work.
Parenting for Attunement happens this Saturday and I reserved a big old space so registration will remain open all the way up until we start the class (so you can walk on in if you don’t register beforehand — I’ll bring extra hand-outs). Our focus that very first day will be on learning more about your child’s temperament and how that can impact their development so that you can choose your own this-size-fits-mine parenting plan.
I hope to see you there.