Finding a therapist who takes your insurance can be nearly impossible
npr.org
npr.org
- Get paid half as much
- Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.
- Get your money later instead of now.
- Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.
- Have to lose patients when their coverage runs out
Meanwhile, there's overwhelming demand for therapists in many cities and plenty of people who will pay cash. I truly believe that many therapists are not in it for the money... but if they are going to make less money, let's at least figure out a way to handle the bureaucracy so that their jobs are more enjoyable.
Insurance understandably does not want to reimburse much for that.
That's a good point, although people don't seem happy to acknowledge it. In my metro area, the biggest providers of mental health services are aligned with religious organizations or outright promote themselves as offering religious based therapy. It's frustratingly hard to get evidence based treatment free from religious influence.
Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.
So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.
I'm guessing they don't. As a US person we hear a lot of, presumably insurance company sponsored, anti-Canadian-healthcare propaganda and then dumb people repeat it online.
This is my experience in BC as an American immigrant. It doesn’t apply to Toronto or Ontario.
Counselors are very easy to find. I had my pick and the wait was about a week. The province didn’t cover it in my case but my extended benefits did. Most of the ones I talked to offer pay scales based on extended insurance coverage, and many will provide pro bono care. Some counselors are covered by the province if you get a referral from a doctor.
The longest I’ve personally waited to see a general doctor is 6 hours at an ER on a weekend night, typically the wait is about an hour if you go to a clinic in the morning without an appointment.
For specialists, appointments are done on a triage system with a referral. If your case is urgent, or worsening you typically get seen asap. I’ve seen MRIs get done same day, or take as long as six months for non-urgent needs.
What I’ve never seen is someone wait a day with a broken arm to make sure they actually need to see a doctor because they can’t afford it. That’s something I saw twice in college in the states.
I’ve also seen people get referred to a specialist and never get seen because their insurance wouldn’t cover it.
Also seen people declare bankruptcy over medical debts in the states despite having insurance.
Canada’s healthcare system could be improved, but if you have ever dealt with low end insurance or uninsured healthcare in the states, you would understand how much better the system is here.
The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally.
And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.
And for that, I'd like you to point me to a state with government-operated medicine that doesn't have a therapist shortage. Because I'm hearing from several people in this thread that their countries have the same problems.
You should also understand that I am not suggesting that insurance companies should be banned. If you don't like the USGOV subsidy, you or your employer can still subsidize private insurance for you. But now, insurance companies have to compete with the government!
I didn't say the IRS was worse, I just said it wasn't any better.
The amount of extreme cases of stonewalling, long holds, call transfers, inconsistent interpretations of policy, requests for faxes that get lost, requests for new paperwork, and general lack of urgency, across numerous companies in numerous states, is mind boggling, and easily an order of magnitude more extreme the IRS experiences I've seen shared here.
raises hand
I have! I've actually worked a shocking amount with the IRS, not because I'm a criminal but because I'm working class and wasn't educated on how to file taxes more complicated than a 1040-EZ, presumably because it was never expected I would make that much money or own my own business.
Strictly my experience, I would much, much rather deal with the IRS than my insurance company. Yes, they're intimidating at first, but ultimately every person I've worked with both at the IRS and my state agency has been calm, professional, and frankly to a degree I found surprising, extremely understanding about how badly I fucked up my taxes on a number of occasions. I was never treated like a criminal; they explained what I did wrong, how they found out, what I owed, and how to prevent those issues in the future. And I was given interest-free payment plans with a one-time administrative cost to setup, that I now pay monthly. I'll be fully 0'd out in about 2 years.
This contrasts sharply with my experience with my insurance company! My insurance company tries to get out of paying for every last thing they can manage. My dental insurance has a maximum pay out of a measly $5,000 per year, which seems completely backwards to every other insurance I have ever had, but what do I know. You know how fast you can crush 5 grand in dental work? And paradoxically it still has co-pays, so apparently I'm paying so they will cover most of some bills, up to a predetermined maximum. Additionally, since I own my own business, I do have the luxury of choosing my own insurance, which most people can't, and for that luxury I pay simply princely sums each month to insure both myself and my spouse. I've picked the best for my area (at time of comment) and have to spend many many days of unpaid labor every year re-evaluating that choice, both because circumstances and networks change coverages, and because every single year my insurance goes up despite both of us, by and large, being quite healthy, and I get fucking annoyed about it and want to see if I'm getting my money's worth. I wouldn't say I am by a long shot, but the alternatives cover less, and cost more, so I'm still paying.
Frankly, and I don't mean this as a personal attack against you, but I have to assume people who talk like you have never interacted directly with the IRS, and are instead absorbing that opinion through the same cultural osmosis I did, because I too was initially terrified to the bone when I got my first letter from them several years after starting my company, and honestly, they are incredibly over-hyped. The only way to truly get the IRS to take you to to task is to, for years on end, purposely try and weasel out of paying taxes.
I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.
> - Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.
> - Get your money later instead of now.
> - Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.
This description could be lifted up and dropped in to be describing my tax situation each year. Meanwhile, I've never interacted with the kind of nightmarish insurance companies that some people have, so I'm strictly comparing two relatively painful bureaucracies, not nightmare stories about either one.
Maybe I'm missing something, but I don't see anyone who brought up the IRS as a model example except for you. It seems like people are just talking more generally about steamlined than the current status quo experience, and there are so many ways to steelman that which have nothing to do with analogies to the IRS.
To your credit you did note that you wanted people to take you up on your suggestion of using only bad examples, but I don't think your insistence on that front holds water because this is the type of thing where the difference that makes the difference is going to be the very details you are asking everyone to gloss over.
> I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.
I'm not at all sure what you're getting at with the rest of your comment, because it doesn't seem to relate to anything I actually said. I'm insistent that we be realistic about what a US bureaucracy will inevitably look like and not expect it to produce less red tape than is already present. I said nothing about glossing over anything.
Also, I attempted to preempt these comments. They're not clever or new or even particularly accurate:
> And to preempt the comments saying it doesn't have to be this way: it doesn't matter if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are
It was, by far, the best insurance I have ever had in the US. It was effectively a gold insurance plan with no deductible, a $2 copay, drug and dental coverage.
It was very easy to sign up for, and the paperwork was literally the exact same as buying marketplace insurance.
I found it to be a better experience, and better administered than any other American health insurance I ever had.
If I could have paid money to stay on it when I got a job I would have.
Every other insurance company I've dealt with has actively cost me money, time and unnecessary pain through ineptitude or beurocracy. My FAANG healthcare was good, but had relatively fewer health issues
Look at the table here: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
The US is spending 50% more per-capita than Norway already and we are worse off. This doesn't include private insurance money which is insane amounts already.
(Hot take: the masters was the truly offensive part of the equation -- most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship, even if your salary is low.)
I shouldn't be surprised, given how much training it took me to get into this field, but being paid nothing and spending years in training was much easier to tolerate at 20 than at 40.
If you're lucky enough to get an unusually good internship.
Won't most of the interns be shadowing someone who is just practicing the same bullshit/pseudo-intellectual woo the elder therapist was taught by the same programs a few years earlier?
Depressed/anxious/whatever people don't generally want to have navel-gazing conversations about gender fluidity and the metaphysical dialectic (or whatever; I'm making up something woo-y). They want to feel better.
LPC - Licensed Professional Counselor, 24 states + DC
LMHC - Licensed Mental Health Counselor, 7 states (NY)
LCPC - Licensed Clinical Professional Counselor, 7 states (IL)
LPCC - Licensed Professional Clinical Counselor, 6 states (CA)
...
MSW is likely Master of Social Work
( https://www.psychotherapynotes.com/decoding-counselor-alphab... )
As far as I know, most states have procedures for licensing several of these categories, and a couple more besides (Licensed Marriage and Family Therapist, for example).
There are plenty of native English speakers in third-world countries. Presumably, some of them could become qualified (from a practical point of view, not a legal point of view) therapists. Therapy can be offered via telemedicine, over the internet. At least some of these people are far enough from US jurisdiction that they could probably offer this service to anybody who wants it over the internet, and just not care what foreign governments have to say about it. This feels like an easy way for people there to make relatively large (by their standards) amounts of money. Why isn't this happening yet?
I’m sure there are fitness/“life” coaches working online from who-knows-where, though. That’s more or less a form of counseling.
It turns out that Kaiser will only cover you if you have a diagnosed mental condition (eg bi-polar / ADHD). If you don't, then you're completely out of luck. Instead, they refer you to use an app where you can get counseling via text message, and it's only for 90 days.
They're more incentivized to not diagnose with a condition.
I was considered not bi-polar and do not have ADHD by a psychiatrist and thus I couldn't get therapy covered.
If it’s that common, then there’s no need for a large bureaucracy of actuaries, accountants, agents, etc…, in the middle or to serve as your intermediaries.
And a single paperwork error every five years, causing you to spend a few hours sorting it out, would more than outweigh all the tiny advantages that might theoretically benefit the customer.
People I've talked to can't quite to wrap their heads around that idea. Not sure why.
As with any for-profit business, benefit to the customer is not a goal in and of itself, but rather an incidental side-effect of obtaining money from the customer, in that it is how the customer is convinced to give up their money.
I would caution against assuming systems such as what you described are intended to help the customer. It sounds like instead, it is intended to help the company, by causing you to have to spend your (not their) time and potentially miss an appointment, saving the insurance company money.
After all, what are you going to do, leave your employer for another one with a different insurance company over an insurance paperwork headache?
I think you might be thinking about this the wrong way. It's not like therapists want to diagnose people with conditions to scam them out of money (which I suspect might be what you're thinking), it's that insurance companies require there to be some specific mental health issue to be willing to cover therapy, so therapists have to come up with some acceptable reason to give to the insurance company.
Insurance companies may accept "adjustment disorder" (which is just basically having trouble adjusting to a life change) for a certain amount of time, but will often want something else eventually, which can just be something like depression or anxiety.
In some sense this means that therapists technically have to "diagnose" something (as in write it down as a possible diagnosis) to bill insurance but usually people are having some sort of issue if they are seeking therapy so it's probably often just a matter of determining what fits.
Arguably maybe it would be better for insurance to cover therapy even without a specific diagnosis, but in any case, having to write down "depression" or something on a form for the insurance company doesn't mean that they're necessarily telling everyone that they have some sort of serious mental condition or need to get on psychotropic drugs (not that therapists who aren't psychiatrists can prescribe those anyway).
Therapists aren't running around diagnosing people who aren't interested in therapy with bipolar or something to get them to hand over their money or to scam insurance companies.
It's not easy, but the key is to tell them you require therapy for something. The tricky part is to walk the line somewhere between "I'm really OK" and "I'm approaching suicidal" ... there is a lot in that range and if you're near the former they won't approve it.
What you have to do is ask your PCP for a referral. You'll get a call from a therapist to screen you. You need to convince this person you need therapy.
If you need further help, my email is in my profile.
I will say that a family member decided to go outside of Kaiser for therapy because the work to get the official referral was just too onerous. I will mention the website they used: helloalma.com -- I have no affiliation with them. The nice thing about it: you can get a few free consultations with therapists after looking at their profiles, just to vet them. The family member was happy with that process and got someone that helps. Also, they list their "out of network" price and at my urging the family member negotiated the rate to be at the low end of the scale ($110/hr). There are many that list their hour rate in the range of $80-240.
Good luck.
That said, I was surprised when I mailed a bunch of bills to my insurer, and requested reimbursement. I figured I was probably wasting my time, but why not see what happens.
Anyway, they mailed me a check. The bills were higher than what my insurance would cover, but my insurance decided to cover a substantial portion.
This is not what I’d describe as “fighting your insurance”.
https://www.dol.gov/general/topic/health-plans/planinformati...
But, rightly or wrongly, reading my health insurance documentation feels to me like staring into the abyss. Indeed, I admit that the expression "clearly stated" provokes exactly the sort of dread I'm describing; it feels like the sort of thing a hospital or insurance company would say while sticking me with a massive unexpected bill.
Whether my reaction is reasonable or not, I can't say, but I do feel deep empathy for the therapists out there who balk at dealing with insurance companies.
The incentives are Kafka-esque. If you're a provider, your incentive is to maximize billable treatment, and you often have prospective patients who have an extremely limited capacity to evaluate your relative expertise/value bs other options, and they often don't have the time luxury of being able to shop around even if they did (and might be justifiably wary of selecting medical treatment based on discounts anyway).
If you're an insurer, you're selling a product with inherently cross-aligned incentives -- the people with the greatest need for it will not be able to pay enough in premiums to meet your risk pool, the people with the least need for it will have limited incentives to buy in. Good actuarial work can partially balance this out but at some level your incentives have to do with attracting/keeping those with the least need for your product and trying to avoid or ditch people with the greatest. On the other hand, other than patient bankruptcy, insurers are probably the single greatest (if limited) force for cost control in the US system, a fact which doesn't frequently win them any love, and thanks to a certain mix of legally compelled and inherent responsibility found in the industry they do at times come through for people, as your experience may indicate.
Given the incentives, the wonder isn't that there are problems for people and providers who don't want to work with insurance. The wonder is that it works at all, and that there is anyone who continues to focus on market solutions. Hayek was about as big a laissez-faire advocate as you can find in the history of economic thought and even he thought that public insurance had things to recommend it over solely private institutions.
Therapists are not considered part of the medical cartel because they are not required to go to medical school or pass the licensing process for “Doctors.” They can’t increase the service costs unilaterally into longer term revenue. This is why it’s trivial to find a covered psychiatrist - because they legally prescribe medicine which is the best possible outcome for an insurance carrier - their equivalent to SaaS margins.
So therapists aren’t legally “Doctors” and as a result they do not have the legal avenues to create an invoice that a health insurance company would accept as mandatory to pay by law. So there’s only downside to an insurance provider for this.
https://www.bbs.ca.gov/applicants/
Therapists are considered healthcare practitioners. They have NPI numbers. They can submit claims for professional services to payers using NUCC 1500 forms or X12 837P transactions, just like physicians.
Therapists can choose to join health plan provider networks, just like physicians. On most health plans even out-of-network therapy is covered, but the patient financial responsibility may be higher. Mental health parity with medical benefits is legally required (although some payers aren't fully compliant).
https://www.cms.gov/marketplace/private-health-insurance/men...
There is a legitimate shortage of licensed therapists in many areas because education is expensive and reimbursement rates are low. Most therapists still work in small, independent practices rather than as part of large health systems so dealing with insurance billing is a huge hassle and overhead. Thus many therapists don't join health plan networks and require patients to pay directly.
I've struggled with various problems and therapy has seemingly always made it worse. We would "explore" things which caused me to dwell and dedicate so much brain power to "untangling" ideas. Eventually, I would always be "cured" after some relentless distractions and not the therapy. I truly believe the therapists wanted to help, and our progress felt real... but looking back, it was probably worse than doing noting.
I bring this up because I believe some people need therapy, but many people are encouraged to seek it out for problems that could be overcome with other methods, causing a "therapist shortage." This has downstream effects, like the one posted here.
On top of that, I have rarely, if ever, found people participating in talk therapy getting better. If it were a pill, no honest doctor would prescribe it.
It is important to remember that anecdotes are not data.
I certainly present anecdotes, and I also live in this world and I notice and I observe and I evaluate. The comment I am responding to does even less.
The second scam is, of course, couples counseling. I have sporadically watched Showtime's “Couples Therapy,” and I know several people who have gone to a couples therapist. The cost of a 50-minute session with the therapist presented on the show seems to be $700. After watching parts of the program, I can give my prescription to all the couples featured, free of charge: You need to break up and find someone else. It may be a collection of anecdotes, but I have yet to see a couple “fall in love again” or “settle their differences” after expensive couples counseling sessions. It's time to move on.
For ADHD, it appears that therapy < medication < therapy + medication.
When compared head-to-head, therapy is almost as useful as medication, but the issue with therapy is that once the patient stops attending, the benefits tend to diminish rapidly.
However, therapy tends to have less side-effects and less stigma. According to some research, medication efficacy also tends to diminish overtime as well.
For other conditions, I cannot tell you. I feel like it would be too large of a brush to try and paint with. I could see conditions like personality disorders not benefiting from medication as much as therapy. Conditions like schizophrenia might not truly benefit from either. For conditions like depression and anxiety, I think the medications are efficacious if not perhaps less so than therapy, but do not quote me on this one.
It is all anecdotal of course but like you, I notice that my friends and family that constantly go to therapy never seem to get better... and often times worse. I don't think its a case of correlation either, I think they've just made a mountain out of molehill.
Now, I do want to say there are _many_ people that absolutely need therapy. I think if you just can't function, you need professional help. That shouldn't be discouraged.
Isn’t this true for any medical treatment?
I'm still "young" so every visit to a Dr, I've come out with a solution.
In any case, I've gone to therapy and it feels like you're making progress (and perhaps I was) but never fixed the problem.
Knew someone that went to therapy b/c they constantly thought the world would end any second. Why? Because they kept going on reddit/the internet where every top comment is "the world will end soon." They would talk about their "progress" and all sorts of techniques. Their life seemingly revolved around their new problem to the point you didn't want to hang out with them very long because it would come back to their issues. IMO, the "cure" to this problem is talking a long walk in a park or downtown and get the hell off the internet. Out of curiosity, I just checked and they're still posting... latest posts are about monkeypox and how it will kill hundreds of thousands... sad to see.
They visit that r/news subreddit and find the worst articles about conflicts, disease and disaster... its like dude just close the laptop! Frustrates me. You do not need to "identify and label triggering content" you need to get out!
Just a quick anecdote. One of my problems was public speaking. This was in HS so my parents and teachers encouraged therapy. Unfortunately, this now meant dwelling on my fear of public speaking 3 times a week. We went so "deep" with why I was afraid but tbh it was probably best to keep it as simple as "I'm afraid to mess up"
I was "cured" of this fear by a damn video game. It was coming out the day of my presentation and 90% of my brain was focused on the anticipation of the game, only 10% left to worry about the public speaking. I got up, did the presentation on autopilot and then realized "oh, this isn't the worst thing ever" and never had a problem after. Sure, I get nervous but before I would actually throw up on days I knew I had to speak so... I consider it cured :)
My therapist was a great and qualified person... but I think I would have never made any true progress... just dwell on and dissected my fear into adulthood.
Your family member is correct. However, the "framework/plan" in that research is not necessarily a manualized empirically supported therapy, it's having some kind of guiding theory about what's going on and a plan for how to proceed. Much more basic than the EST idea. Research generally doesn't show any replicable differential effect of therapy paradigm, especially after you control for publication bias.
Many of those studies of experience and degree were done long ago though, and I'm kind of interested how more recent studies would hold up.
In general though the most important things are having some working theory and plan about the client, rapport and comfort between the client and therapy, things like that. What makes therapy work is sort of nebulous and hard to pin down.
There are studies, for example, showing that there are better therapists than others, but figuring out what makes someone a good therapist has been much more difficult, and to the extent researchers have done so, it doesn't really track well with the manualized protocol-driven paradigms that have dominated the scientific therapy literature for the last 30 years or so.
It makes me wonder if what someone needs is highly individual-specific, and part of the trick to doing good therapy is figuring that out all around, and successful rapport stems from that.
Relevant: "Bad Therapy: Why the Kids Aren't Growing Up" https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/...
...
okay, I didn't want to be that lazy, so looked up the author. (Her name is interestingly not on the cover :o)
Abigail Shrier, hm. okay, at least there's a wikipedia page about her. she seems to be a layman when it comes to psychology/psychiatry. and her 2018 book about "Transgender Craze" ... uh, okay.
...
https://thingofthings.substack.com/p/bad-therapy-review-fift...
"""
Much of Shrier’s book is devoted to critiquing Internet Mental Health Culture, [...] I broadly agree with her critiques.
[Her] preferred alternative to Internet Mental Health Culture is what you might call Fifties Dad Mindset.
[...]
Shrier explicitly says that the right response to “minor cutting” is to ignore it.
"""
Amazing book.
for some people, it's about finding solutions to specific problems, the scope is well defined, nothing wrong here
for others, it's this monolithic worldview that asserts itself as an authority on problems and solutions
The biggest cost to an employer is always their roster. The fewer sick days people need, the less burnout causes them to churn, and the healthier and happier people are overall, the lower the training, recruiting, and redundant staffing cost.
It feels natural to me that in an employer paid healthcare system like the one we have in the us, the employer should demand the highest quality coverage possible by that metric as long as it reduces staffing overheads.
Maybe we should question this assumption that insurance companies intend to compete. It strikes me as very difficult to compare insurance companies. Some of them don’t even keep up to date information about the doctors that are in network (you have to call the doctor to ask).
I mean, does more therapy lead to fewer sick days though? Or more sick days?
Most employees at my current firm stay 2-3 years. That means that if you could "fix" a medical issue, it would often need to pay for itself in a year or two, which is unlikely.
Unfortunately, the economics to seem to favor what the insurance companies are often accused of doing: finding excuses to deny treatment.
Edit: Typo
The same applies to good healthcare - employers WANT their employees to be utterly dependant on them and just barely scraping by so they're stuck.
Crappy coverage is a feature, not a bug.
While in principle I think you're probably correct that providing good mental health services to employees makes for a more productive workforce, it's tough to connect cause and effect in a mathematically rigorous way. We just don't have high-quality studies in this area to establish cost effectiveness. And many employees tend to leave anyway for other reasons.
We really ought to break the link between employment and health coverage. That part never made any sense.
Navigating the Kafka-esque mess is hard enough when you're well. But if you're clinically depressed and struggling to get out of bed, booking an appointment can feel like an unsurmountable wall.
For lesser issues, many employers now offer Employee Assistance Programs (EAP) as part of their benefits package. This can be a relatively quicker path to get a few sessions with a therapist or counselor.
Because finding good people that you click with is hard, whether that’s hiring employees, finding a romantic partner, or finding a therapist.
The online therapy companies that provide an “instant match” haven’t really solved this, any more than a temp agency has solved hiring top talent.
Journalists could use an LLM to fetch the obligatory predictable responses from corporate spokespeople, to insulate the journalists' souls from that.
It's often not that helpful, but it's standard journalistic practice to give them a chance.
So they've been paying her $150 a week for me instead this year. She doesn't know how she ended up being considered in their network as she practices solo, but here we are.
The system is vastly more convoluted than I think anybody on any side actually realizes it is.
This is intentional. It's a game of attrition, and the insurance companies hold all of the cards.
They even have a number you can call when your doctor is recommending you have a procedure to find out where you can have it done at the lowest cost. It's staffed by "nurse navigators" whose job is to dig through their data and find what the average cost has been with in-network providers for other people with your plan and find out which one saves you (and the company) the most money. If you decide to go with one of their recommendations of your doctor's original one, they'll call both providers and arrange to have the relevant documents and approvals moved for you, and then they'll send you a gift card because you saved them money too!
It hasn't been flawless by any means, but it has really seemed like they're on my side and helping me through all this confusing stuff.
And I'm on a marketplace plan with cost-sharing reduction because I'm making sure my income ends up being just high enough not to be on Medicaid, but to get full subsidy plus CSR, so I'm paying <$50 a month for it with $0 deductible and <$2k OOP max.
I've decided they're what I wish all health insurance companies were like.
The big companies already have a pile of cash they’ve allocated for when they get sued, as the cost of doing business.
So maybe a class action suit happens, and insurance companies have to pay $1 billion in damages. Lawyers get their cut, a bunch of therapists get a $1k check, and zero patients get more therapy.
If you are comparing to the population of the world as a whole, then I suspect that's because many people in poorer regions simply don't have access to therapy.
If you are comparing to wealthy industrialized nations (e.g. Western Europe and Scandinavia) then I suspect that America's lack of work life balance, lack of social safety net, repressive moral culture, high gun violence, etc. play a role.
I suspect that in some cultures people like pastors and family members play some of the role of therapists to a greater degree than in America.
Are Americans in therapy directly affected by those issues, or - how can I put this - merely worried about those issues in general terms?
The Economist wrote recently about how political views appear to affect mental health in the USA. The title feels unnecessarily inflammatory, for which I apologise, the article's content feels much more balanced.
https://www.economist.com/united-states/2024/04/04/are-ameri... ( https://archive.is/iWAaP )
Almost by definition, anyone who is directly suffering from the lack of a safety net -- because they are falling through where it would be, and living on the street -- is unable to gain access to therapy, because they wouldn't have money to pay for it.
>It is possible that liberalism does not just correlate with sadness but may exacerbate it. Musa al-Gharbi, a sociologist at Stony Brook University, has noted that educated, affluent white liberals have come to endorse the idea that America is systemically racist, leading them to view other racial and ethnic groups more warmly than their own. “This tension—being part of a group that one hates—creates strong dissociative pressures on many white liberals,” he wrote in the journal American Affairs. Another hypothesis, advanced by Jonathan Haidt, a social psychologist, and Greg Lukianoff, a lawyer, is that liberals are performing a reverse cognitive behavioural therapy on themselves: promoting not resilience and optimism about incrementally improving the world but catastrophic rumination about problems such as climate change and fearfulness of disagreement even on university campuses. Such habits of mind can deepen depression.
I smell Great Replacement Theory bullshit. Even liberal white people still like white people. Even "diverse" shows have white people. Even comparatively less-racist places STILL have an advantage for white people.
This just isn't real. Sorry, it's made up.
So even if it doesn't happen to them, it may directly effect them.
"Gun violence" is of course factually a non-issue in America. Being scared of guns is like being scared of shark attacks or being struck by lightning- technically possible, but realistically such a small risk for the average person that it rounds to 0. But, if you follow certain news or get your social media algorithms tuned to show you certain content, it can seem like this big scary thing.
I also can't really fathom what "repressive moral culture" someone is imagining in America today. There has never been a time of greater tolerance for diverse sexual expression, recreational drug use, religious freedoms or alternative lifestyles. In 2024 you can be a tattooed queer polyamorist pagan who goes to Burning Man for a week and then returns to your corporate finance job on Monday.
But, all the "content for you" algorithms everywhere on the internet will have huge swaths of people afraid of their neighbor and society at large and believing they're under attack and marginalized.
Around 80 deaths per year, including adults and children, by lightning strikes. Versus 120 deaths by guns PER DAY, including adults and children.
https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7250-H.pdf https://wonder.cdc.gov/mcd.html
Additionally, when most of ones accessible news sources are full to the brim with polarizing topics, this leaves with limited options. I'd venture a guess that most people would like to hear what is going on in the world around them, even if the news is as negative as it is.
As the Declaration of Independence says, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." This is not a uniquely American sentiment, indeed the phrase was largely borrowed from the writings of John Locke, an Englishman -- but it does feel very American to me. (Moreover, the fact that about half the signers of the Declaration were slaveholders puts an odd twist on it, which also feels quite American.)
If some aspects of your life are going well, and not others? It feels American to me to believe that you can have it all, that if you're experiencing problems then you should not grin and bear it, but rather that you can and should solve them.
This is my personal conjecture, and of course is highly debatable.
But there is a whole cottage movement of people advising people to go see a therapist to deal with all sorts of (controversially and arguably) benign stuff. Everything from bad breakups, to "toxic traits" they need to address, to family issues, to "issues" they got told is the cause of their dating woes, etc. I haven't been able to put a finger on it definitively, but it's present and is definitely influencing people.
If I were to put my "right wing" hat on, I'd respond and say it's because of all those damn lefties urging people to "talk about their feelings and stuff". That might be a tad too dismissive, but there is something to it behind the pointed accusation; and we all know how heavily pervasive social-media is at driving the behavior of the American populace, aided by the heavily-left-leaning tech companies which actively don't allow the natural immune reaction society has to large-scale gaslighting.
For all we know, people are being gaslight on a large scale, and therapy is trying to put a bandage of it because all these affected people can't reconcile the real world with the craziness of "The Narrative". Some people maybe just need someone to talk to too, you know? Maybe there is more of that in America because they're all forced to self-censor and repress themselves.
</rant> This turned out to be a rant and I let my bias show.
Edit. Now that I think about it, there is arguably even more censorship in the EU so maybe that's not it. Perhaps it's more blatant and people all know it's "forbidden" speech, rather than being forced or gaslight into thinking their thoughts are wrong.
Therapists don't typically prescribe medication, but they have a role in the pipeline of prescribing it
Assuming you didn’t: as a non American who emigrated to the US, the answer is fairly clear. My home country (UK) pretends like if you need therapy you either mentally weak (time to man up!) or on the verge of an inpatient psychiatric hold. Marriage counceling is just a desperate prelude to divorce from people that can’t see the writing on the wall. I would never _ever_ tell anyone on the UK if I was taking psychiatric meds.
America doesn’t have the same stigma, at least in the coastal states. So people get help. People talk about getting help.
Modern life stress is not limited to the US. It’s just the US that talks about it the most. Mental illness is not limited to the US either, they’re just more willing to use medications. And it saves lives. Had I been in the UK with mental illness I have (just the very commmon depression/anxiety power combo) I might be dead by now.
I also take great exception to the idea that there has been some seismic change in life that has resulted in more mental health crises. They were just manifested via more normalized alcoholism and home abuse instead.
Americans have been breaking down the stigma and some have money, so they get therapy. In other countries this may not be the case.
As depressing as it is, I bet there's a table out there that covers this (and the risk that the replacement is poached from some other company that pays the same insurance company).
I think therapy with a professional would be really useful if you have no idea what your problem is, but I think if you're able to put your problem into words then LLMs can be useful.
Made it super easy for us to find one. My wife saw one literally in walking distance from our house.
Some of health insurance looks like this, but many parts of it don’t.
Many folks I know that have private clinical practices address the tension between this and ensuring that there's access for people that can't afford the full rate out of pocket by charging a really high rate for most patients and then doing sliding scale/pro bono work.
you put in your insurance and location, and they find you a provider.
also, some therapists don't take insurance (or recommend you don't use it) because supposedly if you do, then part of that agreement is that they tell the insurance company your treatment plan, which includes the diagnosis, that may be available to your employer. doctor/patient confidentiality seems like there are some exceptions here.
Not just a shameless plug, either: I really believe in their mission, and did a short stint with them.
Therapy doesn’t seem like healthcare . People enter the system and receive care without recovery
It just seems like legitimized drug dealing. Just make the psychotropics over the counter and save the world hundreds of billions
Fun fact, therapy is usually not covered by Medicare at all( and when it is you can literally have a year wait). So you have a system in which working class person just have to get through it, and anyone with means will be told they have dozens of things wrong with them.
Better Help sells user information. The venture capitalist tech bros have a new market.
When I was at my lowest, broke , without any health insurance at all, I had a friend who listened to me complain about my latest eviction for hours at a time. That did more for me that any therapist ( who almost always watch the clock to cut you off ).
I plan to pay for her children to go to college. I make a tech bro salary and it's not a lot of money to me.
The Quest For Community and Tribe are great books on what's wrong with modern society. In my grandma's time the average person attended church ( I'm am atheist, but I value the community aspects), at least one social club, and she was a member of a union.
How many community connections does the average person have today ?
Exactly why healthcare should be a human right and not a business. As someone who’s grown more conservative over the years, this is where I draw the line. Unfortunately since people will always see mental health as secondary to physical, this will always be overlooked.
At the thing that personally affects you. Just like all conservatives: all problems are fake problems until they're real for you. Disgusting.
Comments like these are lazy, destructive and downright judgmental. They only further explain why we can’t get along, take care friend.