And you thought
deciding whether or not to see a counselor was tough. Brace yourself!
An even more difficult decision awaits...which counselor do you see?
How do you find a counselor that's a good fit for you?
For starters, perhaps an
insider's view of the world of counseling would be helpful. Health
Maintenance Organizations (HMOs) and insurance companies have made this
world much more complicated than necessary. Let me try to decipher some
of what you may know, and educate you about some things you may not
the strict guidelines of your particular HMO, which limit you to a
handful of counselors, you DO have a choice of providers for your
counseling process. Not only can you decide from among those providers
covered by your HMO or insurance, but you can find private
practitioners who will take you on as a client. There are many
professional counselors who are not "providers" for an HMO (some like
me, by choice). Considering these providers significantly broadens your
choices when it comes to finding a counselor that is a good fit for
you. So, even though they may not be "covered" by your HMO, many
counselors in private practice would take you on as a client, and work
with you regarding the cost per session to make it affordable for you
without utilizing your HMO coverage.
There is in my opinion, a number
of reasons you may want to consider seeing a counselor who is not part
of an HMO-driven counseling agency. First and foremost, HMO's are
primarily about money – saving and making as much as possible. While I
understand the business side of counseling and the need to make money,
I also believe that any business which delves intimately into people's
hearts, minds and souls should have more in mind than the bottom line
of making money. And, though the counselors working within these
systems may be very competent, kind-hearted and altruistic, the "good
ole boys" at the top of the HMO's are not; their main concern is making
money! This inevitably creates problems for many of the counselors
trying to deliver quality care within this system. I know because I
once was one of these counselors. Try as I might, I just couldn't
provide the type of quality counseling I knew was possible within the
parameters of this large money-making "HMO machine". My focus on ethics
and the welfare of the clients, versus the HMO's focus on turning a
profit, seemed to too often knock heads.
Secondly, the quality of service
at some of the larger HMO's can be compromised. Again, not necessarily
because of the counselors themselves, but because of the constraints
they are made to counsel within under the direction of an HMO. Take for
example, a scene I witnessed while working in one such environment. A
counselor was getting ready to go out into the waiting room and greet
her client -- a woman she had seen several times before. I overheard
the counselor say she felt rather uneasy, because without the
receptionist there to guide her, she had no idea which woman in the
waiting room was her client! This counselor had so many clients in her
caseload, she could no longer remember what her client even looked
like! Unlike a counselor in the HMO system, a counselor in private
practice has complete control over her/his schedule. Therefore, your
chances of getting quality counseling (which includes your counselor
recognizing you, as well as your specific issues!) are greatly
of the large volume of clients herded in and out of HMO agencies, not
only is each counselor's caseload incredibly large, but the number of
clients per day is equally excessive. While I was working in such an
agency, it was common to have seven clients scheduled in an eight hour
day. I learned very quickly, that with the intense work of counseling,
it was virtually impossible for me to deliver the same kind of quality
counseling to my seventh client, as I had to my first.
One last point to consider
when working with an HMO agency is scheduling. Depending on the system
and your choice of counselors you may have to wait a long period of
time before getting in for an initial session (anywhere from two weeks
to one month); and some clients report waiting even longer to try and
book a second session. Is this good counseling? Is it even ethical? No.
Is it a necessary evil within a huge HMO system? Yes.
As a result of these kinds
of schedules on a daily basis, many counselors "burn out". Some choose
to "get out" (of the system, that is) before they are the next burn out
statistic. Others begin to become unhealthy themselves by working
within such a system, thus creating unbalanced, stressed out
counselors, who are trying to help equally stressed out clients. Kind
of a "crazy-making system" that in many ways harms the counselors and
the clients they see. The only folks who benefit from such a system are
the folks (usually white males) at the top, reaping all the financial
desire for time and money-saving therapy have led to the creation and
endorsement of some therapy practices that are questionable at best and
unethical at worst. For example, counselors within these systems are
encouraged to use "brief therapy." Said to bring about changes quicker
by focusing only on the problems at hand, the real gem of brief therapy
for the HMO is that counselors can move large numbers of clients in and
out the doors in assembly-line fashion, thus saving money and time in
"unnecessary" future sessions. Much like a band-aide over a gaping
wound, the result for the client is temporary relief, followed by
continued pain down the road.
Another time and money-saver for
HMO's are drugs. The use of anti-depressants and other medications
continues to sky-rocket. According to the July, 2001 issue of Natural
Health, "On average, every American swallowed more than $460.00 worth
of prescription drugs last year." Pushing medications is advantageous
to the HMOs because dispensing and filling a prescription is much
cheaper and more efficient than paying for several hour-long counseling
when it comes to following up with clients on medications (meds.),
HMO's have devised "group med. checks". With no regard for
confidentiality, clients are now told that if problems with their
medications occur, they can sign up for a "group med. check" in which
they can sit with any number of complete strangers and share their
personal concerns about their medication. The result for the HMO --- a
huge savings in time and money, because one therapist can meet with a
large number of clients at one time. The result for the clients --- no
confidentiality, no personalized time and attention--- in essence, no
quality follow-up care.
long-term consequence for you to beware of when choosing a counselor is
the whole "diagnosing" issue. All HMO's (and most private
practitioners) utilize the "medical model" of psychotherapy. This means
that you will be given a diagnostic label from the Diagnostic and
Statistical Manual, Fourth edition (DSM-IV), which will go into your
permanent medical records. And though there are pre-existing condition
laws to prevent this label from affecting you when you switch insurance
providers, I have heard many accounts in which people were denied
insurance coverage because of these labels in their medical records. As
a counselor in private practice, I choose not to buy into the medical
model. I embrace a holistic approach to counseling, which does not
include diagnosing, but focuses instead on facilitating the growth of a
client who seeks improvement in her or his life.
And when it comes to permanent
medical records, don't count on yours being completely confidential in
an HMO setting. Most HMOs closely monitor your progress to prevent
paying for more sessions than "necessary." They do this by receiving,
in some cases, detailed information from your counselor about you, your
life, and your "treatment plan." In this computer age, it is possible
that confidential information like this could be accessed by almost
anyone. This, I believe, is a violation of your guaranteed right to
confidentiality when working with a counselor, but is required in any
HMO system. As a private practitioner, I operate on a fee-for-service
basis, which allows clients to pay on their own. Without any
interference from HMOs or Insurance companies, I am not obligated to
release any of your personal information.
All that being said, the choice
remains yours regarding whether you look for a counselor within your
managed care system or seek a private practitioner. I strongly
encourage you to ask questions when you are choosing a counselor for
yourself. Don't be afraid to spend some time interviewing your
counselor. This person will soon know many intimate details about you,
and so it is vitally important that you learn as much about them, as a
professional, as possible. (If your request to meet informally with
them and ask some questions is denied, this might be your first clue to
steer clear of this counselor).
The following are some possible
questions to ask the counselor you're considering seeing during your
- What are your counseling credentials?
It is important that the counselor you're considering have a
minimum of a Master's Degree in Counseling or Social Work. Though other
people may be skilled at listening and helping (friends, family
members, priests, ministers, etc.) they may not have the therapeutic
training or skills necessary to provide you with the best help
- What is your counseling philosophy?
Your goal here is to learn more about how, specifically, the counselor
works with her or his clients. If the response isn't meaningful for
you, for example, if the response is "I use a Cognitive-Behavioral
model", or "I most often use Transactional Analysis", ask her or him to
explain, in detail, what that means in terms of how they might work
with you during the counseling process.
- How many clients do
you currently see?
lingo, What is your current active caseload?)
- How many sessions do
you typically conduct per day?
- How far out
are you booking?
(How long will I
have to wait to get in to see you?)
three, four and five will help you determine whether or not the
counseling you receive will be the best quality possible, and whether
or not you will be able to access counseling in a timely manner.
What specific type of information will be shared about my counseling
sessions? Who will this information be shared with?
Ask to see the specific information that will be shared with
the insurance company or HMO, so you know what will be placed into your
- What will you record
as my diagnosis, and what does that specific diagnosis mean?
Ask the counselor to rate the seriousness of the diagnosis
she or he has assigned you, and how its presence in your permanent
medical records might affect you down the road.
- Are you now
in or have you ever entered into counseling as a client?
This question is very important to ask, and a healthy
counselor should respond with a resounding "yes". While a counselor
does have specific training in life-skills, she or he doesn't have a
"get out of life's problems free" card. Everybody has issues, concerns
and opportunities for growth in life -- counselors included. If the
counselor you intend to see doesn't value the process of counseling
enough to engage in it her or himself, you might have a basis for some
serious doubts about the overall health of this counselor. In fact most
quality training programs require all their counselors-in-training to
take part in counseling as a client to deal with their own life issues.
After all, counselors can only help clients to be as healthy as they
Trust your intuition.
That "gut feeling" or inner knowing will let you know in no
uncertain terms whether or not you are comfortable with a particular
counselor. Just take the time to tune inward and listen. Not every
client will be a match for every counselor. If the match isn't good for
you, based on any of the above responses to your questions, or based on
your intuition, don't be afraid to move on.
Best of luck in your search for a
counselor, and peace to you along your journey toward wellness!