Higher frequency therapy

[Midnightmoon]

Any words of wisdom from anyone whose got though to the other side of high frequency therapy? I'm at 3 hours a week now, recommended by my T as I'm struggling and they felt upping contact would help. This feels so 'abnormal' from the standard 50 mins a week and my head is exploding with how much of a nightmare client I must be. I've tried to talk about it with them, they keep talking about how it's just a stage of growth, that it's healthy. My head doesn't compute. Healthy to me is never having to turn up in a therapy office ever again! I just want to be average.

 

[Sideways]

This feels so 'abnormal' from the standard 50 mins a week

Where does that standard come from!?!

I’m in therapy once every 3-4 weeks right now. Which is perfectly normal. It was also perfectly normal when I was in therapy 5 days a week, with 3 different therapists.

There’s no normal therapy. There’s no normal recovery. There’s only what you need right now.

 

[Midnightmoon]

Where does that standard come from!?!

I’m in therapy once every 3-4 weeks right now. Which is perfectly normal. It was also perfectly normal when I was in therapy 5 days a week, with 3 different therapists.

There’s no normal therapy. There’s no normal recovery. There’s only what you need right now.

Those words were exactly what I needed to hear, thank you!

 

[Wendell_R]

Just to second Sideways' experience, I've been in therapy 2 1/2 hours a week for a few years, which was a big increase from the 45 min I did for a long time. Recently, my therapist and I just agreed to drop to 2 hours a week for now, and likely down to 1 1/4 hours in the near future.

 

[Friday]

When I’m paying for therapy my normal is 120 minute sessions, twice a week. Regardless of what type of therapy it is. ADHD, PTSD, Life. Because that’s how much time I work best in.

As that’s the standard time for EMDR appointments, the trauma therapists I’ve seen already have those time blocks either built into their schedule, or the form the foundation of their schedule.

But that’s just my normal.

- When doing trial prep, or similarly difficult processing? Double that. 4 hours a day, 4 days a week.
- I’ve worked with a couple of therapists who prefer 3-5 hour sessions once a week. Those were stellar experiences, and totally outside my frame of reference until the first time.
- I’ve worked a couple of different jobs (where everyone is living/working together for several weeks/months) that have therapists embedded with the team, so there’s 24/7 access, even if most of that is just normal living.

There are quite a few other time-models…

Spoiler: For Example

- one of my professors would spend 3 hours a day at her OCD new-mom client’s home every morning, and 2 touching base phone calls in the afternoon / evening for 6 months… transitioning to 3 phone calls a day over the next 6mo. <<< That’s a fairly standard OCD New Parent course, for people whose symptoms become so severe they make parenting -or even functioning at any level- impossible. >>> My professor would only take on a small number of these clients per year, but she adored the process. Get up. 5mile walk with the dog. Shower, breakfast, dress, drive to clients house. Spend a few hours with them. Meet girlfriends for coffee. Go into office meet with 2 clients before lunch. University to lecture after lunch. Office hours or clinic hours, after lecturing. Go home for dinner/family/swimming.

^^^ All of our professors would lay out their various schedules for us, because baseline, clients often attempt to insist on their right/responsibility to dictate their therapists’ lives. But that’s neither their right nor their responsibility. That’s the therapist’s. And whether regimented or freewheeling, one has to be very secure in one’s own boundaries in this area. Especially if one chooses to concentrate / specialize in certain types of disorders/clients. Similarly, if that’s not an area of strength? Our professors didn’t just say “then being a therapist isn’t for you”. Instead? To align their career into a setting that does that for them. Like working in a hospital, where there are 3 shifts of therapists; or for an agency that despises therapy (Like fire, EMS, & law enforcement) where your client base is actively avoiding you, rather than stalking, attempting to micromanage, or often in crisis; or taking on gig-work that has a set time limit (like trauma therapists who head for natural disasters); etc.

- DBT = 6 mo of 24/7 access to therapists (in person or via phone/zoom), individual & groups sessions multiple times a week… followed by 6-12mo of gradually declining access, individual, & group time.

- Early Intervention therapy is daily, for years.

- Misdiagnosis & Dual Diagnosis therapy is usually inpatient for 1-18mo, intensive IOP (daily) for 6-24mo, OP for several years.

- I could go on, and on, and on. Different disorders? Different “normals”

What you’re describing as “normal”? Is one-size-fits-none McTherapy that even the crappiest of insurance companies are willing to pay for. That’s not “normal”. It’s just one of the many costs of being poor.

I just want to be average.

Average is NOT scraping the bottom of the barrel. Which is what 50 min once a week is.

AVERAGE is doing the best you can, within the constraints that afflict you (poverty of time, money, or talent). Whether that’s 50 minutes once a month, or 2 hours every other day, or having a therapist on staff/retainer. As above average means 2:3 are no object, and exceptional means you knock it out of the park with the BEST of all 3:3.

<cough> Word to the wise? The only group of people I have eeeeeeever encountered who are hyperfocused on “normal”? Are victims of abuse. It is a HUGE tell.

Healthy to me is never having to turn up in a therapy office ever again!

Agreed.

However, many of the healthiest people I know have zero need of therapy, but still use therapy to make their amazing lives? Even better.

The difference between need & want; having to v choosing to.

 

[Midnightmoon]

My only experience of therapy, before being in therapy, was Dr Google, who kindly tells you that a few months of weekly 50 min appointments and you'll be sorted. I'm learning it's not like that at all! The time differences are so reassuring, all be it also an uncomfortable truth of where I am at the minute. Maybe three hours is just what is needed for now

 

[Wendell_R]

I can see the huge difference in therapy response between my wife, who's been grieving about her parents and has made good progress with a handful of months of sessions, versus me, with dissociative disorder and heavy CPTSD from when we were very young. Dr. Google doesn't capture that difference so well!

 

[whiteraven]

Average is NOT scraping the bottom of the barrel. Which is what 50 min once a week is.

I could never afford more than that. I don't understand how other people can!

 

[Friday]

I could never afford more than that. I don't understand how other people can!

Sometimes I’ve had decent to great insurance.
Sometimes I’ve had a spare 3k per month.
Sometimes I’m scholarship’d or probono’d or sliding scale’d in
Sometimes I go years without therapy.

- Decent insurance? It doesn’t cost anymore for 120min sessions than 50min sessions. Same copay ($10-$20).

- Great insurance? Doesn’t cost anymore for 120min sessions than 50 min sessions. Same copay. ($0) Plus? No deductible & no annual limit. Can do 2 120 min sessions per day, 5 days a week for “free” (IE whatever my insurance bill is).

 

[whiteraven]

Decent insurance? It doesn’t cost anymore for 120min sessions than 50min sessions. Same copay ($10-$20).

- Great insurance? Doesn’t cost anymore for 120min sessions than 50 min sessions. Same copay. ($0) Plus? No deductible & no annual limit. Can do 2 120 min sessions per day, 5 days a week for “free” (IE whatever my insurance bill is).

I have ok insurance for everything else. No copay, not a huge deductible, but twice that for out-of-pocket. My current T doesn't take insurance and charges me peanuts, but the psychiatrist I used to see was $320/hr. He terminated because I had a balance on my account ($58).

The only T I ever saw for more than once a week was a psychiatrist in the 80s who charged $80/hour. I was forced to go, wasn't working, and it took me 5 years to pay that off. And he only made me worse. Never doing that again.

 

[Freddyt]

Mine has varied from 1 to 3 weeks, based on where I am and what we are working on. When ever we went to higher frequency I found my T was spot on and knew what they were doing, but generally its every three weeks.
I have a psychiatrist I visit a couple times a year to have him offer all sorts of pharmaceuticals - mostly to keep my GP happy. (and paid under Canadian Health care where psychologists are not.....)

 

[Friday]

My current T doesn't take insurance and charges me peanuts, but the psychiatrist I used to see was $320/hr. He terminated because I had a balance on my account ($58).

So… from working in healthcare? Billing is a ______ (service, privilege, etc.). Just because a provider does not bill for you, or is not a preferred provider (paying thousands to tens of thousand per year)? Does NOT mean you cannot bill your own insurance, yourself.

The most basic format is in 10s. All insurance companies accept 10 bill groupings. Some accept single, or multi batch groupings. It’s “just” a form you fill out, and attach receipts to.

Unless? Your therapist isn’t licensed, and therefore no insurance will pay.

But IF they’re licensed? Regardless or whether they’re preferred (in network), or out of network (don’t pay the insurance company for the bene), you can send your insurance company batches of 10 visits & be reimbursed for in/out of network care.