My choice to work in private pay

There are a number of reasons why I’ve chosen to keep my therapy practice running on out-of-pocket, non-insurance-based pay for sessions. At the core of it is a certainty that I’ll do my best work if I have the flexibility granted by independence from insurance companies, and if I want to help my clients live out their own certainties, well, I’d better follow my own.

I don’t want to diagnose you

Most of my clients need relief, perspective and a space in which to be more fully seen - not a diagnosis. To be paid by an insurance company I’d have to submit a diagnosis earlier than I feel is right for something that will remain on your medical records. We’ll find plenty of words for what you’re living through, but they might not be words in the DSM. For those clients that would benefit from a formal diagnosis, I’m able to help name it or refer out when there is an undeniable psychiatric need.

It’s important to keep my practice right-sized

Insurance companies dramatically undervalue the benefits of therapy and the efforts of clinicians. I’ve learned that to show up for my clients with the presence, attention, and care that I feel is right I must keep my caseload smaller than insurance repayments would allow.

I can adjust my practice to reflect my values as life changes and evolves

As I work independent of insurance companies, I’m not beholden to shifts in company policy that my run counter to my own best practices and values around therapy. If I can make my own choices then it’s worth considering and reconsidering the ways I do things, and make changes in my practice as life and the world change. I can work to manage my practice in a way that’s sustainable and effective, providing it the kind of long-term care and attention I hope to cultivate with my clients. I can decide to adjust fees when it’s important to do so, hold important boundaries around cancellations, and work eclectically to meet the eclectic humanity of the people who walk in my door. It’s independence and freedom that allow me to do that and more, and this choice to work on private pay is a part of that freedom.

This choice means I won’t be able to work with each person who may wish to come my way. But it means that for those who can and choose to make the investment in their lives that therapy requires I can show up more fully, with more certainty, and do my job well.

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