03/24/2008 02:05 pm ET Updated Nov 17, 2011

Are You In Therapy?

Eliot Spitzer has apparently started therapy. Good for him. Better late then never. Are you in therapy? Should you be? Do you need it?

Twenty years ago, when I got my license to practice therapy, everyone was in therapy. The economy was pretty good, health insurance paid well for therapy, and there were no HMOs involved. At least in Los Angeles and New York it was common for people to start their sentences with, "My therapist says..." Since then, things have changed considerably.

When the HMOs came in, the advice was to sign up with them. "They will fill your practice with clients and if you don't, you will have a tough time," I was advised. So I signed up. I signed up with an HMO that handled university students. It was the university I went to for my masters, so I figured it would be good to give back. The insurance company would send me a client, not many by the way, with three sessions approved. After that I would have to call them to get more approved and document why this client needed more treatment. They were entitled to ten, total, if they could get that many approved.

They sent me a gal, 21, who had been very religious and was about to get married. She was having trouble sexually and revealed to me, in our third and last approved session, that she had been sexually abused as a child and had never told anyone. I immediately called the insurance company to get more sessions, as there had never been a clearer case of need than this gal, and the faceless "therapist" at the other end of the phone said, "You need to send her to a free group like Adults Molested as Children. I will not approve more sessions." And he didn't. I had to tell this young gal that I was sorry but I couldn't get more sessions for her.

The other HMO I signed up with was a bit better about approving sessions. I found out this was because they had no intention of paying me, anytime soon, so what did they care how many hours I worked. You need more sessions, fine with us. I send the bills, no payment. This particular HMO made me call them, show up, plead, etc... just to get paid. They paid about 1/3 of the normal and customary fee for therapy, by the way.

With these experiences being commonplace for insurance related work, I unsigned up with all the HMO's and insurance companies, as did many of my esteemed colleagues. We now only work with people who can afford our fees up front and if their insurance will reimburse them, that's fine but we are no longer in the mix. As a result, not many people can afford therapy anymore. You may need it, want it, know that it will help you, but you have to be pretty comfortable financially to get it. What Mr. Spitzer was paying for sex would have paid for a lot of sessions. He can afford it. He also needs to pay for the therapy his wife and daughters now need as well. Not such a big problem for him, but what about you?

If you need therapy, and can afford it, you can get the best care. I encourage you to take advantage of it. Everyone could benefit from having someone in their corner, every week, to touch base with, get support, listen to your every concern and help you out of a depression or even just a rut. If you can't and need to use your insurance, good luck to you. The best and brightest no longer take insurance for therapy. It seems that even doctors are pulling out of insurance work. Pretty soon the health insurance companies will just take all our money and pay for nothing.