Why Are Many Men Reluctant to Get Help in Therapy When They Need It?

As a psychotherapist in private practice in New York City, I'm seeing more men seeking help now than I did 20 years ago, but many men are still reluctant to get help in therapy when they need it.

Why Are Many Men Reluctant to Get Help in Therapy?

According to a 2020 survey, even though more men seek help now than before, there are many men who need help who don't seek it. In addition, fewer men seek help in  therapy compared to women.

Men Who Are Reluctant to Get Help in Therapy

Even though many well-known male athletes and celebrities have spoken openly about seeking help in therapy, there's still a stigma about men seeking help (see my article: Mental Health Awareness: Reducing the Stigma of Getting Help in Therapy).

Here are some of the most common reasons why men avoid getting help in therapy:

• A belief they must conform to traditional gender roles and that "being a man" means never showing emotional vulnerability

• They don't know how to show emotional vulnerability

• They're not sure what they feel

• Even if they know what they feel, they don't know how to talk about it

• A belief that going to therapy means they're "weak" (see my article: A Common Myth: Going to Therapy Means You're "Weak")

• Going to therapy makes them feel ashamed (see my article: Overcoming Shame)

• Going to therapy makes them feel embarrassed

• A belief they should know how to handle their problems on their own without getting help

• Psychotherapy is out of reach for them due to a lack of mental health services in their area or they can't afford it (in New York there are sliding scale therapy services in psychotherapy institutes with therapists in training who are supervised by senior therapists, including Institute For Contemporary Psychotherapy which also takes some health insurance).

How Can Men Learn to Talk About Their Problems?

Over the years, I have worked with many men who seek help in therapy because their partner encouraged them and, in some cases, insisted that they get help.

Here are some of the things I do to help men who seek help:

• Normalizing the Need For Help: Since I know many men don't know how to talk about their feelings, I start by trying to help them to get comfortable talking in sessions and normalizing how awkward it can be, at first, for anyone to talk to a therapist. I also provide them with psychoeducation about therapy including letting them know that many people start therapy with a degree of anxiety and ambivalence (see my article: Starting Therapy: It's Not Unusual to Feel Anxious and Ambivalent).

Men Who Are Reluctant to Get Help in Therapy

• Creating a Safe Space in Therapy Sessions: In order for clients to feel comfortable talking in therapy, I create a safe space for them by being compassionate, nonjudgmental and going at a pace that works for them.  

• Helping Clients to Relax: For clients who are anxious, I often start the session with a breathing exercise to help them transition from wherever they came from so they can relax and be present in the room.

• Starting Wherever They Want to Start: In our culture, it's generally considered more acceptable to talk about "stress" than anxiety or depression, so a lot of men (and women too) start therapy by saying they're experiencing "stress" and they just need some tips on how to manage their stress.  I will start wherever a client feels most comfortable, so if they want to talk about ways to manage stress, I'll start there.  But what usually happens, after these clients get comfortable talking to me, is that they begin to open up and talk about what is causing them stress including problems in their relationship, problems with their children, elder care issues, issues at work, unresolved trauma and so on.

Men Who Are Reluctant to Get Help in Therapy 

• Choosing Whether or Not to Work With Goals: Some clients like to set goals early in therapy. Others feel that setting specific goals feels like too much pressure. So, I allow clients to decide how they want to work.  At the same time, I want the sessions to be meaningful to them so we might need to find a balance so the therapy doesn't just "drift" in a scattered way.

• Helping Clients to Identify Their Feelings: Many men have been raised since early childhood to suppress or ignore their feelings so that, as adults, it's difficult for them to know what they feel. Therefore, helping these clients to recognize and identify feelings is often a significant part of the work.

Men Who Are Reluctant to Get Help in Therapy

• Using Humor and Lightheartedness: Using humor, when appropriate, can help clients to relax and open up. 

• Encouraging Self Compassion: This is an essential part of the work in therapy, especially for clients who have internalized harsh messages from early childhood about what it means to "be a man" (see my article: Acceptance and Self Compassion).

• Encouraging Self Care: Many men who are reluctant to get help in therapy are also reluctant to take care of their physical health and overall well-being, so encouraging self care is often an important part of the work (see my article: Self Care Is Not Selfish).

• Encouraging Support Outside of Therapy: The problem for many men is they don't talk to anyone about how they feel even if they have people in their life who would be supportive. In addition, many men don't have partners or close friendships, so encouraging them to develop an emotional support system outside of therapy is important (see my article: Overcoming Loneliness and Social Isolation).

Suicide Rates For Men

Men's mental health struggles often go undiagnosed because they avoid getting help.

In the United States, men represent about 79% of all suicides, which is four times higher than women.

Approximately 36,000 men commit suicide every year in the U.S. due to undiagnosed mental health and/or substance misuse problems.

Many of these deaths could have been prevented with professional help.

Note: If you or someone you know needs immediate help for suicidal thoughts, call 988, which is the suicide prevention lifeline or go to your nearest emergency room.

Getting Help in Therapy

The first step, which is making an appointment, is often the hardest.  

Getting Help in Therapy

If you have been struggling on your own, you could benefit from getting help from a skilled mental health professional.

Most clients who are initially reluctant to start therapy usually discover that therapy helps them to overcome their problems so they can lead a meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapist.

I have over 20 years of experience helping individual adults and couples for a variety of issues, including trauma (see my article: What is a Trauma Therapist?).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at 917.742.2624 during business hours or email me.

Slut-Shaming Women and Girls is a Form of Bullying and Sexual Harassment

Slut-shaming is a form of bullying and sexual harassment of (mostly) women and girls.  It's not new--an early example of slut-shaming is in The Scarlet Letter, a novel written by Nathaniel Hawthorne which was published in 1850.  

Slut-Shaming is a Form of Bullying and Sexual Harassment

The story takes place between the years 1642-1649 in the Puritan Massachusetts Bay Colony. The main character, a young woman named Hester Prynne, has a child from a man she isn't married to and whom she refuses to identify to the local ministers who are demanding to know the father's identity.

As a result, the punishment for her "sin" is that she must stand on a scaffold in town for three hours to be shamed and ridiculed by the townspeople. In addition, she must wear the scarlet letter "A," which stands for adultery, for the rest of her life.

What is Modern Day Slut-Shaming?

Let's start by defining modern day slut-shaming (see my article: The Madonna-Whore Complex is Still Alive and Well Today).

Stop Slut-Shaming

Modern day slut-shaming is a term used for the act of judging, stigmatizing and bullying girls and women based on their appearance, sexual attitudes and their actual or perceived sexual habits. 

Although contemporary society no longer requires girls and women to stand in the town square to be shamed, current day bullies have other ways to degrade and humiliate them, including verbal harassment and cyberbullying with posts on social media.

Anyone can be slut-shamed, but teenage girls and women of all ages are usually the targets for violating sexual norms from the perspective of the harassers.  

This form of bullying and sexual harassment can occur with or without the intended target's knowledge either in person or, as mentioned before, on social media.  Unfortunately, social media provides a platform for slut-shaming which can reach millions of people.

Girls and Women Are Not Asking For It

There is often an attitude among people who engage in this form of sexual harassment that girls and women are "asking for it" by wearing certain clothes or engaging in certain sexual behavior.  This attitude is a form of misogyny.  

According to the American Association of University Women, slut-shaming is the most common form of sexual harassment in middle school.  

Schools can also, unwittingly, create the atmosphere for slut-shaming by requiring certain dress codes for girls that prohibit them from wearing clothes that reveal "too much skin," but the same schools often don't have the same dress code for boys.  

Girls in these schools are often penalized for "distracting boys" with revealing clothes.  This is a form of scapegoating and victim-blaming. It sends a dangerous message to everyone that girls are responsible for boys' "uncontrolled" behavior.  It also blames girls who are sexually harassed and assaulted by indicating that it was their own fault.  

Examples of Modern Day Slut-Shaming

The following examples represent only a few of the many ways that girls and women are slut-shamed:

• A woman who is wearing a sexy outfit is criticized (by men and women) as being a "bimbo," "hoe" and other derogatory names to her face as well as behind her back.

• A woman who enjoys sex is degraded verbally to her face as well as being gossiped behind her back.

• A woman who has an extensive sexual history is verbally attacked by her boyfriend (or spouse) in an unrelated argument.

Stop Slut-Shaming

• A woman discovers that a former boyfriend placed a sex video of them on social media without her consent (see my article: What is Revenge Porn?).

• A high school girl, who is about to text her boyfriend with a sexy picture of herself, is shamed by her friend.

• A middle school girl comes to class one day and discovers her classmates are gossiping about her because a boy she dated revealed she allowed him to touch her breasts.  At the same time, this boy is praised by his male friends for the same acts for which the girl is denigrated.

• A high school girl discovers that her classmates are criticizing her sex life on social media.

The SlutWalk and #MeToo Movement: Reclaiming the Word "Slut"

Even celebrities aren't immune from slut-shaming.  Some of the most visible cases of slut-shaming on social media have included celebrities like Miley Cyrus, Kim Kardashian, Ariana Grande and Amber Rose.

After she was slut-shamed by her former husband, Amber Rose created the SlutWalk in 2015 where she gave a speech to talk about her personal experience.  In addition, she has spoken out publicly about the purpose of the Slutwalk as giving women a voice for gender equality and to address sexual injustice, victim blaming and derogatory labeling.

The Slutwalk is one way that women have reclaimed the word "slut." With regard to the origin of the word, it seems to have been used originally by English poet Geoffrey Chaucer who used the word "sluttish" in the 14th century to describe untidy men.  Eventually, "slut" was attributed to kitchen maids and "dirty women" and was followed by the more contemporary sexual connotation that has been used to scapegoat women in general.

The reclaiming of the word "slut" is intended to deal with external misogyny as well as the internalized misogyny experienced by women.

The Slutwalk also provides a way for women to tell their own stories and provides words of empowerment for other women who have endured this form of sexual harassment.  It has become an international movement which calls for the end of rape culture, victim blaming and slut-shaming.

The #MeToo movement has also served to empower women and raise people's awareness about sexual harassment and sexual violence.

The Psychological Effects of Slut-Shaming

The psychological effects of slut-shaming can be traumatic and long lasting.

Slut-shaming has been linked to 

• Depression
• Anxiety
• Feelings of guilt and shame 
• Problems with body image
• Low self esteem
• sexual anxiety
  
• Sexual guilt
• Suicidal ideation
• Suicide 

Seeking Help in Trauma Therapy

If you have experienced slut-shaming, you could benefit from seeking help from a licensed mental health professional who specializes in helping clients overcome psychological trauma.

Trauma Therapy

A skilled trauma therapist can help you to overcome trauma, rebuild your confidence and improve your overall well-being.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a trauma therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Can Modern Day Age-Gap Relationships Last?

The term "age-gap relationships" refers to relationships where the age difference is at least 10 years or more.  These type of relationships are also called "May-December" relationships.

Age-Gap Relationship: Older Woman With Younger Man

Growing Social Acceptance, But There is Still Some Social Disapproval

There is growing social acceptance for age-gap relationships because many people believe that "age is just a number." They don't see the age difference as a deal breaker.  

In addition, people are generally living longer and healthier lives so they can enter into new relationships more easily than people from past generations.

There are also famous examples of relationships where there is a large age gap, including French President Emmanuel Macron and his wife, Brigitte, who is almost 25 years older than him. And, as of this writing, they have been married for 15 years.  

Despite growing acceptance, there is still significant social disapproval and a stigma against age-gap relationships.  An individual's sex, culture and age are determining factors as to whether someone approves or disapproves of these relationships.

Although most people prefer to be with someone close to their own age, in the Western world, it has been estimated that approximately 8% of heterosexual relationships are age-gap relationships with an age difference of 10 years or more.  

Historically, age-gap relationships have involved older men with younger women.  But there are now more older women and younger men who are entering into these relationships (see my articles: Relationships Between Older Women and Younger Men - Part 1 and Part 2).

There are also gay, lesbian, bisexual and transgender age-gap relationships, but there's not as much research about them.  Hopefully, there will be more research in the future.

Why is There Still a Stigma Against Age-Gap Relationships?

A stigma still exists based on a long history of suspicion about relationships where there is a big age difference.  

Age-Gap Relationships: Younger Woman With Older Man

The most common reason for this stigma is the perception that one of the people (either older or younger) is using and taking advantage of the other person.

If it's an older man and a younger woman, many people believe he's "creepy" and going through a midlife crisis, and she's a "gold digger."  

If it's an older woman and a younger man, many people believe that he's a "gold digger" and she's having a midlife crisis and trying to recapture her youth.

Underlying some of this judgement and criticism might be a lack of understanding about what brings two people together--regardless of their chronological age.

In addition, there might also be an element of envy among people who are living a more conventional life and who secretly wish they could live outside the confines of tradition.

What Are the Possible Advantages and Disadvantages of Age-Gap Relationships

It's important to recognize that, just like any two people, the individuals in an age-gap relationship are unique individuals in particular circumstances.  So, what works for one couple might not work for another.  

At the same time, generally speaking, there can be certain challenges and benefits to these relationships.

    

    Possible Challenges:

• Different Life Stages:  This is probably the biggest perceived challenge of age-gap relationships.  Although this isn't necessarily a challenge for every relationship where there is a big age difference, it can be a challenge for others.  For instance, there is often a challenge if one person wants to have children and the other has already had children and doesn't want any more or they are unable to have children due to age (although there are now medical advances to address infertility and other options, like adoption).  If children aren't a consideration, different life stages can be easier for the couple to negotiate.

• Power Dynamics: When there's a significant age difference, there could be problems with power dynamics with the older person, who has more life experience and who might have more money and professional success, having more power in the relationship than the younger person (regardless of sex, race or sexual orientation).  However, this is an issue that can be worked out if the couple is aware of it, communicates well and makes an effort to change it.

    Possible Benefits:

• Living Longer: Some people in age-gap relationships live longer.  This might be due to a healthier outlook on life as well as a younger partner's ability to take care of the older partner later in life.

• Many Younger Men Prefer Older Women (and vice versa): Younger men who are in relationships with older women often say they prefer older women because they have more life experience, and they tend to be more confident, assertive and mature. Also, older women often know what they want both in and out of bed and usually have more sexual experience than younger women (see my articles: Who Says Older Women Don't Enjoy Sex? and Many Older Women Remain Sexually Active).  In addition, many older women say they get along better with younger men, who have the same youthful outlook as they do.  They also see younger men as healthier more energetic than most older men.  In addition, older women and younger men are often more sexually compatible.

• Many Younger Women Prefer Older Men (and vice versa): Similar to younger men who prefer older women, younger women, who are attracted to older men, often say that older men offer more emotional and financial stability.  As compared to younger men, older men are often established in their career and they have more time for relationships.  Also, since they are no longer focused on building a career, they often have more time for relationships.  Similarly, older men often prefer the company of younger women because of their youthful outlook and appearance.  Also, they can still have children.

Reframing Concepts Related to Age-Gap Relationships

People who in age-gap relationships are usually well aware of the social disapproval and stigma associated with their relationships.  

In certain situations, the adult children of the older person attempt to interfere with the relationship because they fear their parent is being taken advantage of (as previously mentioned) or that they will lose their inheritance to the parent's younger partner.  The older partner would be wise to address these issues directly with his or her adult children instead of allowing suspicion and resentment to grow.

Social disapproval, stigma and family conflict often mean that there can be conflict within the relationship due to external pressure.  But if the couple is able to work on and transcend these difficulties, they can build a stronger relationship.  

Tips on How You Can Have a Lasting Age-Gap Relationship

While there are no guarantees for any relationship, regardless of age, these tips can help a couple to have a happier relationship when there's a big age difference:

• Share Your Expectations With Each Other: Knowing what you each want and expect can be helpful for navigating the differences in an age-gap relationship.  This helps to avoid misunderstandings and disappointments.

• Embrace Your Differences: Regardless of age, there will be differences between two people in any relationship.  Every couple is unique.  If you both know, accept and appreciate that you're each at different stages of life, your relationship is more likely to succeed.

• Focus on Mutual Interests: You and your partner might have come together initially because of mutual interests.  When you enjoy these interests and activities together, you can both enjoy each other more than if you're focused on your age difference.

• Be Willing to Explore Your Partner's World: Your partner might have a unique perspective in certain areas.  A willingness to explore those perspectives can make life more interesting and exciting.  It can also help you to grow and bring the two of you closer together.

• Talk About Possible Caretaking of an Older Partner: Rather than shying away from this challenging issue, talk about it in advance.  Know what you each want and expect and what would be involved.

Conclusion

Although there is still some social disapproval, there is growing acceptance of age-gap relationships in our society.

In the end, it all comes down to the two individuals in the relationship.  

Talking about your expectations, embracing your differences, focusing on mutual interests, showing a willingness to explore your partner's perspectives, and talking about real life issues involved when there is an age difference can contribute to the success of an age-gap relationship.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples in traditional and non-traditional relationships (see my article: What is Sex Therapy?

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Mental Health Awareness: Reducing the Stigma of Getting Help in Therapy

May is Mental Health Awareness month.  As part of Mental Health Awareness month, The National Alliance of Mental Illness (NAMI) has chosen the theme of reducing the stigma of mental illness, "Cure Stigma" as its theme this year to acknowledge that a stigma still exists for people with mental illness as well as a stigma for getting help in therapy. In addition, NAMI also to provides information, encourages people to get help, and provides advocacy for people with mental health problems.

Mental Health Awareness: Reducing the Stigma of Getting Help in Therapy

Treating Physical Symptoms Instead of the Underlying Emotional Problems at the Root of the Problem
Research has shown that one in every five Americans has a mental health problem, but many of these same people suffer in silence and never get help.

As a result their symptoms often get worse or develop into physical symptoms.  For instance, a person with untreated anxiety might develop headaches, backaches, digestive problems, insomnia or other physical problems.

Whereas this person might feel ashamed to get help for his anxiety, he feels much more comfortable seeing his primary care doctor about his physical symptoms because there's no stigma about the physical symptoms.

What Are the Consequences of Treating Physical Symptoms Instead of Treating the Underlying Emotional Problems at the Root of the Problem?
With regard to the example above, it's this person's doctor might treat only the anxiety-related physical symptoms without ever treating the underlying anxiety.

The doctor might provide this person with anti-anxiety medication for insomnia, which might help the insomnia, but then the underlying anxiety can manifest in another symptom--like irritable bowel syndrome (IBS).

At that point, the primary care doctor might refer the patient to a GI doctor, who might send this same patient for a CT scan to rule out any serious internal problems.   Finding none, the GI doctor will probably prescribe a different type of medication for the IBS to control the symptoms.

This can go on for quite some time as the anxiety-related symptoms manifest in all different physical symptoms because none of the doctors are dealing with the underlying emotional problem, which is anxiety, that is at the root of the physical problems.

But if someone with similar problems happens to have a primary care doctor who is trained to know that psychological problems are often at the root of medical problems, after the doctor has ruled out more serious physical problems, the doctor will advise the patient to get help in therapy.

Why is There Still a Stigma For Getting Help in Therapy?
Although it's now somewhat more acceptable for people to get help in therapy, many people, who need help, are afraid to seek the assistance that they need for a variety of reasons related to the stigma of going to therapy:

• They judge themselves harshly for needing help and feel ashamed.
• They believe they should just "get over" their problems.
• They believe they would be "self indulgent" or "too self centered" if they went to therapy.
• They believe only rich people attend therapy.
• They think that only "crazy" people seek help in therapy.
• They believe, far from being real, their problems are only in their imagination.
• They feel they don't deserve help.
• They believe that they must be "weak" if they need help (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak").
• They believe they will have to remain in therapy for a long time to overcome their problems (see my article: Common Myths About Psychotherapy: Therapy Takes a Long Time).
• They're worried about what their family and friends might say if they found out that went for help in therapy.
• They believe the therapist will judge them.
• They don't know about Federal confidentiality laws, so they believe that their therapist might tell their employer or other people about the problems they discuss in therapy.
• They believe that going to see a therapist means they're paying the therapist to be their "friend," which makes them feel ashamed because they believe a therapist couldn't actually care about them.

What Can You Do to Reduce Your Fear of Getting Help in Therapy?

• Know that you're not alone.  There are skilled mental health professionals who can help you.
• Know that a skilled therapist has experience helping other clients with similar problems to yours and she won't judge you for your problems.
• Know that a licensed psychotherapist can't divulge your information under Federal law without your written consent unless you're an active harm to yourself or others (you have a thought, intent and plan to hurt yourself or someone else and you refuse to make an agreement with your therapist not to take action) or you're engaging in child abuse (psychotherapists are mandated reporters and must report child abuse to the state).
• Know that seeking help in therapy doesn't mean you're "weak."
• Know that seeking help in therapy doesn't mean you're "crazy."
• Know that everyone needs help at some point in their lives and everyone is deserving of help.
• Talk to trusted family and friends who would be supportive of your getting help.
• Know that you can see a psychotherapist for an initial consultation to see if you feel comfortable with her and to obtain psychoeducation about how therapy works (see my article: Why It's Important for Psychotherapists to Provide Psychoeducation About How Therapy Works).
• Know that you decide what your therapy goals are, you're in charge of your therapy and you can go for as long as you want to go.
• Most psychotherapists are empathetic towards their clients' suffering.  You're not paying them to be your "friend."  You're paying them for their expertise and time to help you to help yourself.

Conclusion
There are many reasons why people avoid going to therapy even though they would benefit from it.

Although it's considered much more acceptable to go to therapy now than it was in the past, there is still a stigma among some people about going to therapy.

Psychoeducation about psychotherapy is important, and you can consult with one or more psychotherapists to get this information and see which therapist is right for you.

Rather than suffering on your own and risking that your problems will get worse, you would benefit from getting help from a licensed mental health professional so you can resolve your problems and lead a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples (see my article: How to Choose a Psychotherapist).

I use Emotionally Focused Therapy (EFT), recognized as the leading couples therapy, when I work with couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Ethical Issues With Using Managed Care For Psychotherapy

In a prior article, I discussed why it has become so difficult to find a psychotherapist in New York City on managed care panels.

This is a problem not just in New York City but all over the country.  In the current article, I'm expanding this discussion to include ethical issues involved with using managed care for psychotherapy.

Ethical Issues With Using Managed Care For Psychotherapy

The purpose of this article is to provide information to clients who are considering using their managed care benefit to attend psychotherapy so that clients can be informed consumers.

Ethical Issues About Using Managed Care For Psychotherapy
Managed care companies' main focus is saving money.  Although most managed care companies would deny it, their allegiance is to their shareholders--not to their subscribers.  When saving money is the main focus, this inevitably leads to certain ethical problems, including:

• Problems With Client's Privacy/Confidentiality:  When a psychotherapist enters into a contractual agreement with a managed care company, she will, most likely, have to share your confidential information with managed care representatives because it is demanded by the managed care company.  In effect, not only is the confidential information shared with the representative on the phone (or sometimes by mail or on the insurance company's website), but the information also becomes available to hundreds of other employees at the managed care company.  This is becoming even more of a problem than when I wrote the about this before because in the last few years there have been breaches in confidentiality when insurance companies sites were hacked.  This exposed thousands of insurance subscribers to having their personal information used illegally, possibly including information about their psychotherapy sessions.

• Problems With the Intrusive Nature of Managed Care: Managed care representatives often contact in network psychotherapists to find out why clients are still in therapy; to make "suggestions" about how psychotherapists should change clients' treatment plans, including referring clients for medication, even when clients have made it clear that they're not interested in medication; and, possibly reducing the frequency of sessions from weekly to every other week or less.  Often, the managed care representatives demand that psychotherapists justify their clients' treatment in writing in order for clients to be able to continue in therapy.  This often involves the representatives asking for detailed personal information about the clients' problems; what else the clients have attempted to do, aside from going to therapy (e.g., joining support groups, seeing a psychiatrist, etc) and so on. 

• Potential Conflicts of Interest For Psychotherapists on Managed Care Panels: To save money, managed care companies prefer short term treatment, even, at times, when clients are in crisis or very depressed and they need longer term treatment.  Many psychotherapists who are on managed care panels are aware that they are more likely to get referrals from managed care if they do brief therapy--even when clients need more intensive therapy.  This often leads to psychotherapists, who are on managed care panels, making decisions based on their financial needs rather than the needs of their clients.  In other words, if a psychotherapist is aware that a managed care company prefers psychotherapists who do brief treatment, he will be placed in an ethical dilemma because he knows that the managed care companies will look at their records to see which therapists only keep clients for a short period of time before terminating treatment so, in the long term, it is in his financial interest to keep clients for only a few sessions so he can get more referrals from the managed care company.  This often leads to poor treatment because the psychotherapist might only be focused on "shoring up" clients rather than helping the client to make meaningful change.  Clients might "feeling better" for a short time and then, after a while, they need to go back several other times to the prior therapist or to a new therapist because their problems were not resolved in short term therapy.  It also discourages clients from seeking help in therapy because, after going through several cycles of short term therapy with poor results, clients will often conclude that "therapy doesn't work" rather than that their therapist might have been pressured by managed care to provide suboptimal care.  This is not to say that all psychotherapists on managed care will choose less than optimal care because many will do what is best for the client, but it is a potential ethical dilemma.

Ethical Issues With Using Managed Care For Psychotherapy

• Potential Problems With Quality of Care:  As mentioned above, when psychotherapists on managed care panels are pressured by the insurance company to provide short term therapy, even when the client needs longer term therapy, the quality of care often suffers.  In order to justify longer treatment, psychotherapists often must go through a lengthy and time consuming process of providing increasingly more detailed information as to why clients need more therapy sessions.  Not only is this time consuming for the therapist, it also compromises confidentiality, as mentioned above.

• Pressure From Managed Care Regarding Medication:  As mentioned above, managed care companies often pressure psychotherapists to refer clients to psychiatrists for medication, even if the clients do not want to take medication and, in many cases, do not need medication.  Often, the representatives making these clinical "recommendations" are Bachelor's level employees, if that, and far less qualified to make these clinical decisions than the psychotherapist treating the client.  Once again, the focus is on saving money rather than  providing quality of care for clients.  

• Restricted Choice of Psychotherapists:  In order to save money, most managed care panels are narrow with a restricted number of psychotherapists listed by zip code.  This saves the managed care company money because there are fewer psychotherapists to choose from and the ones who are on the panel, who are often are other managed care panels, are forced to take many clients in their private practice in order to make financial ends meet due to low managed care reimbursement.  This usually meets that it is very hard to find a psychotherapist in your area who has openings because therapists are all booked up.  Also, many of the therapists (although not all) are new therapists who are starting their private practice and willing to take managed care until they can build their practice.  

• Diagnosis and Stigma: Managed care for psychotherapy is usually based on medical necessity, which means that a client must have a diagnosis that the managed care company deems necessary to cover this client.  As a result, psychotherapists must provide a diagnosis to the managed care company for each client that the managed care company will accept.  Once again, this brings up issues around confidentiality and privacy because these diagnoses are on the managed care computer system.  Also, as mentioned above, when a managed care company's website is hacked, the client's confidential information, including diagnosis, could be exposed (see my article: see my article: Psychotherapy: You Are Not Defined By Your Diagnosis).

What to Do to Avoid or Mitigate These Problems With Managed Care
Obviously, there are many clients who must use their managed care plan because they cannot afford to self pay for therapy.  If this is the case for you, you should, at least, enter into this process knowing what is at stake.  If this is the only way that you can access mental health treatment, it's better to use your managed care insurance than not to go to therapy at all.

Steps To Take to Be An Informed Consumer

• Find Out If Your Company Has a Health Savings Plan:  This is an alternative to using your managed care benefit that many people use.  Your human resources or health benefits representative should be able to tell you if your company has a health savings plan, if you are eligible for the plan, and how to use it.  If your company does not have health savings plan, you and other employees can advocate for this benefit.  Express your concerns to your concerns about these issues and find out what steps the company can take to remedy them.

• Find Out If Your Insurance Allows Out of Network Psychotherapy: When you go out of network, your benefit is not managed by the managed care company, although there might be some restrictions with regard to the deductible and how much the insurance will reimburse you depending upon the plan that your company negotiated with the insurance company.  If your company does not offer out of network benefits, you and other employees can advocate for it.

• Discuss Your Concerns With Your Psychotherapist: If your company does not have a health savings plan, out of network benefits or if you really need to use your managed care benefit, speak with your therapist about your concerns regarding diagnosis, confidential/privacy and quality of care.  You have a right to know the diagnosis that your psychotherapist is submitting to the managed care company.  You also have a right to know what information your therapist is providing to the managed care company if the insurance representative indicates to your therapist that they must do a review of your case.  You can stipulate what you want/do not want shared.  However, be aware that if your therapist does not share information that the managed care company considers necessary to approve additional sessions, you might not be able to continue in therapy.  This is another ethical dilemma.

Ethical Issues With Using Managed Care For Psychotherapy

• Consider Your Priorities:  Only you know your financial situation.  There are times when you might be forced to use your managed care health benefit to access therapy because you cannot afford to pay out of pocket.  This is understandable.  But it is often worthwhile to look at your priorities and assess how your spending your money and how you want to spend your money.  Take a look at your budget and make decisions based on what is important to you.  At certain times, it might be worth it to you to forgo certain expenses, like buying packs of cigarettes or buying expensive coffee in order to have quality mental health treatment.  

• Consider Sliding Fee Scale Mental Health:  There are certain mental health centers that offer sliding scale therapy based on household income.  Most of them will request proof of household income in order to assess your fee.  Many of the psychoanalytic institutes have referral services to their candidates in training where you can see a licensed psychotherapist in their training program for a reduced fee.  These students are usually supervised by senior clinicians.

Getting Help in Therapy
Many people need to use their managed care health benefit in order to access psychotherapy.  However, many of those same people are unaware of the issues involved with using managed care benefits for psychotherapy.

No one who needs mental health services should ever go without treatment regardless of whether you use your managed care benefits or not.   At the same time, it is important to be an informed consumer.

If you have problems that you have been unable to resolve on your own, you could benefit from seeing a skilled psychotherapist who can help you to overcome your problems (see my article: The Benefits of Psychotherapy).

A licensed psychotherapist can help you to overcome the problems that are keeping you from maximizing your potential (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Psychotherapists Need to Stop Labeling and Stigmatizing the So-Called "Help Rejecting" Client and Be More Creative Instead

One of the most unhelpful labels that a therapist can pin on a client is the so-called "help rejecting client" or, worse still, "the help rejecting complainer."

Stop Labeling and Stigmatizing the So-Called "Help Rejecting" Client

No matter how a therapist tries to qualify these labels by saying that he or she understands that the client isn't intentionally rejecting the therapist's recommendations or that the client is responding this way out of fear, there's no way around it, these labels are pejorative and damaging to the therapeutic work.  And I can't help feeling that using these labels is a way of blaming the client, making him "wrong" and making the therapist "right."

Generally speaking, clients who are referred to as "help rejecting" are often seen as finding reasons why interventions the therapist attempts in treatment won't work or responding to the therapist's treatment recommendations with, "Yes, but..."

No doubt, when this happens, it's frustrating for the therapist and the client.

Reconceptualizing the So-Called "Help Rejecting Client"
I think it's time that mental health professionals reconceptualize these outmoded labels and begin to "think outside the box."

Better yet, I think we should "retire" the terms "help rejecting client" and "help rejecting complainer" in much the same way we retire certain baseball uniform numbers.  Let's agree to stop using these labels.

I'm not saying that therapists are actually calling clients "help rejecting" to their faces.  It's more of a term used in psychotherapy literature, although I've also seen it written about in certain therapy blogs for the lay public.

Many people might disagree with me, but I think that even if a therapist never utters the words "He's a help rejecting client,"just thinking about the client in this way has the potential to sabotage the therapy.  After all, if the client is "help rejecting" and the therapist's job is to help, what's left to do?

The Client's Fear and Ambivalence
There are clients who are ambivalent about treatment and about making changes.

If you've lived your entire life relating in a certain way and engaging in certain behavior, even if behaving in these ways has caused a lot of emotional pain, it's scary to venture into unknown territory to change.

If a client is afraid to make a change, it's up to the therapist to help the client to feel safe.  The old maxim of "starting where the client is" comes to mind.

This could mean that the therapist might need to get out of his or her "comfort zone" to try something different.  It could mean working in a different way from how he or she would.  This is why it's important to have many different ways of working because therapy can't be a one-size-fits-all endeavor.

It could also mean seeking a consultation with a more seasoned therapist.

In some cases, the therapy might take longer than the therapist and client anticipated.  At times, it might be frustrating for both the therapist and the client.  But the therapist can't go any faster than the client is willing to go.

Engaging the Motivated Part of the Client That Wants Help
Most people understand that, as human beings, we're complex.  Even when we say we want to change, there's often a part of us that doesn't want to change at all.

It's up to the therapist to understand the part of the client that fears change and to engage the part of the client that came in wanting help.

At the start of therapy, the more dominant aspect of the client might be rejecting what the therapist has to offer.  But, usually, underneath the fear and ambivalence there's an aspect of the client that wants to change but doesn't know how.

After all, if a client spends the time and money to come to therapy every week, there must be some aspect of him or herself that wants to change or s/he wouldn't be there.

Therapists Need to Be Creative
Gone are the days when the therapist can take a "neutral stance" with the client.  Good riddance to the days when the therapist sat back and just said, "Uh huh," retraumatizing the client as he poured out his problems!

Therapists need to learn to be creative in their work to help the work come alive.  They need to be a presence in the therapy room rather than being neutral.

Clinical Hypnosis and Somatic Experiencing
There are many creative ways to overcome therapeutic impasses with clients who are ambivalent and/or fearful about change.

I often find clinical hypnosis and Somatic Experiencing to very useful in helping clients to soothe the part of themselves that fears change and connect with the aspect of themselves that wants to change.

Talking about these aspects of self without helping clients to connect to where they're feeling these emotions in the body is very limited.  Talking about it often becomes an intellectual exercise that doesn't lead to actual change.

Helping the client to have a "felt sense" of these conflicting aspects of him or herself makes the therapy come alive in a way that regular talk therapy often doesn't.

Helping Clients to Use Their Imagination
Helping the client to use his or her imagination in an embodied way can open the door for the client to have a "felt sense" of internal and external resources to invoke.

Over time, clients can learn to use these resources to have a corrective emotional experience that wasn't available to them before.  At that point, the client has access to more of him or herself to do the work to make changes.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.