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Counseling, Health Insurance and Mental Wellness

If you want to use health insurance when you visit a counselor, you currently have no option other than to work with a licensed clinician and receive a diagnosis – the two requirements for licensed clinical therapists to receive reimbursement from insurance companies. The problem with this is many people who see a therapist aren’t dealing with a mental condition that requires a diagnosis. Yet when a diagnosis is given, a variety of things can come with it including the stigma, the concern and a potentially permanent mark on your medical record.

All clinical diagnoses for mental disorders are referenced from DSM 5 (Diagnostic and Statistical Manual for Mental Disorders, 5th Addition). But what if you don’t actually have a “disorder?” What if you are simply struggling with some aspect of your life (since struggling itself doesn’t necessarily constitute a disorder) and just need someone to confide in who is a skilled, curious, unbiased observer? What if you need support during a difficult time in a relationship? What if you are going through a life transition and need some encouragement and guidance? What if you want to work on some skills to improve your relationships at work?

With this said, I want to make it clear that people seek emotional support and counsel for a variety of reasons. For example, if one is suffering from severe depression or psychosis, it is wise to seek counsel from someone who specializes in treating these conditions and is licensed to do so, particularly when medication is necessary. In addition, if a person is suffering from any severe mental illness it is critical to get an accurate diagnosis that describes the condition so that appropriate care can be coordinated and provided. A diagnosis can also be very useful for a person suffering from such conditions to have a clear understanding of what they are experiencing.

If you don’t have severe depression or another serious mental illness and you want to use your insurance for counseling, many clinicians give a diagnosis of “Generalized Anxiety Disorder NOS (not otherwise specified).” Anxiety in some form usually accompanies struggle or physical disease, so it likely does apply, but what does this diagnosis actually mean? In my opinion, when the traditional insurance system frames a person’s struggles and difficulties as “disorders,” it’s not only inaccurate, but it does not honor the natural process of living as it somehow repackages life struggles as something “wrong” with you, when in reality you might just be having a hard time or are experiencing growing pains of some kind.

Another potential problem with being given the “disorder” label is that it trains a person to see oneself through the lens of the disorder when in reality one is far more than a “disorder”. Maybe the opposite is true. Maybe you are struggling because you are fundamentally well but the struggles are simply signals that you need to make some changes to realign things in your life. Your being attuned to being out of balance may actually be a sign of health, not the opposite. Or perhaps you are in a situation where there is prolonged and intense suffering, like working in an emergency room or dealing with a loss or financial difficulty, and the healthy, natural response to what you are experiencing is to feel deeply troubled. Perhaps the disorder diagnosis might be better applied, in some instances, if you didn’t feel like there was a problem.

Additionally, being diagnosed with a “disorder” in order to use insurance sometimes means your therapist must advocate on your behalf with the insurance company to get them to pay for more than just a handful of sessions,. In these instances, your therapist must make the case for why you are still “unwell” and therefore you need more treatment. This serves people well who are not particularly concerned with how their struggles are framed and recorded, so long as they can utilize their insurance benefits.

Again, I want to emphasize that there are many instances where this system serves a valued and necessary purpose, specifically with the mentally ill.

What are your options if you do not want to participate in the requirements of the insurance system when paying for counseling? You can work with a skilled and creative licensed psychotherapist and ask that they not submit a diagnosis if it does not adequately describe your circumstances. Of course, you must be willing to pay out of your own pocket. The other option is to work with a therapist, counselor or coach who is trained, creative and skilled but who works outside this traditional system.

Wouldn’t it be great if our mental health care system developed a Diagnostic and Statistical Manual for Mental Wellness? It would include positive diagnostic labels for those seeking preventive support or striving to relate more effectively with others. All of the labels in this manual would describe and validate a person’s basic wellness and acknowledge their being proactive in seeking resources for increased well-being.

What a game-changer this would be!


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