FAQs

If people you trust have been in therapy, ask them if they would recommend their provider as a fit for you. 

Be aware that they may not feel comfortable in “sharing” their therapist.

If they do share the name, ask additional questions about the therapist as pertains to you and your needs.

This is a good starting point, but it is important to check out the referral beyond the recommendation. Research based on the categories below

 Physicians who specialize in psychiatry—M.D. and other physician designations 2. Doctoral degree level practitioners in one of the licensed mental health fields (see #3 below)- Ph.D., Psy.D., Ed.D., and other doctoral level designations 3. Master’s degree level practitioners in one of the licensed mental health fields (see #3 below)- M.A., M.Ed., M.S., and other master’s level designations 

There are five mental health licenses available in Missouri.* Providers in each field meet licensing qualifications set by state statute involving degree, curriculum, experience, and internships**. If you think you might need prescription medication, note that not all licensed mental health providers are licensed to conduct a medication evaluation or issue a prescription.*** When the therapist you choose does not prescribe, you can ask your Primary Care Physician (PCP) or visit another provider (for one example, a psychiatrist) to handle the medication portion of your therapy. {The list below refers to Missouri. Other states have the same or similar titles (and potentially additional ones) for their licenses.}

Counselor-LPC

Marriage and Family Therapist- LMFT

Psychiatrist-MD

Psychologist

Social Worker-LCSW

* You can check your state licensing board for the licenses available in your area. . 

*** Check your licensing board to learn what professions in your state are licensed to prescribe medication in addition to physicians. 

Professional experience ranges from the newly graduated student who holds a provisional license to practice while under supervision, to a licensed therapist with several years in the field, and all the way to the seasoned professionals with decades of mental health experience. 

Each mental health field has professional associations which providers may join. Professional membership signifies support for and identification with that particular field of practice. Inquire about the provider's professional memberships. 

Regardless of the years of experience, all licensed practitioners remain updated in the profession through the Continuing Education Units (CEUs) required for license renewal and through the professional associations of which they are members.  

 As you begin your search for a therapist, consider whether a specialist in a particular field is the right choice for you.

Within mental health, specializations are commonly documented by 1. a state license; 2. certification or a certificate of training or transcripts-CEUs issued by an official organization in a targeted area; or 3. a qualified clinical membership in a professional organization.

Aside from providers who are marriage and family specialists documented by an LMFT license and/or a clinical membership in the American Association of Marriage and Family Therapists (AAMFT), you can check with other providers as to their specialty area credentials -- as needed.

Inquire about the therapist's specialization in areas important for you such as, but not limited to unique therapy techniques and modalities (for example, EMDR and hypnosis), chemical dependency, sex addiction, gambling, psychological testing, autism spectrum disorder, geriatric, eating disorders, sexual abuse, and many more.

While experience is a great teacher, considering asking about the therapist's documented training/support for that specialty. 

In addition to the above differences, how well you experience a personal fit is important. How you describe your personal fit is just that---PERSONAL. Only you can decide… but, of course, the therapist will also have his/her sense of fit with you. 

No professional can be the “best fit” for every client.

Without a “good enough” fit, it may be difficult for you to remain open and not feel judged by the therapist. A working rapport with your therapist is a key to a successful therapy experience.

Gaining a feeling of comfort early on is essential. Yet in the absence of an immediate glaringly negative issue, 2-3 sessions might be necessary to get a sense of fit---especially, in order to move past a first session where you might receive an observation from the therapist that is “difficult for you to hear”. In that case, you need another session or two to discuss your perception with the therapist and digest it further. “Avoiding” an unwanted message is not beneficial. Make every effort to confront the issue and then decide whether to continue or move on to another therapist. 

For some folks, the gender of the therapist is a “non-issue” while others have a preference. Certainly, whether to honor that preference is your call; however, consider the possibility that the “person” of the therapist is a more critical factor in a fit than gender is. 

How might you benefit from a private pay model?

Consider dedicating out-of-pocket funds to your mental health and well-being---which does not necessarily "cost" more. Consideration/selection of an out-of-network or private pay therapist can deliver unexpected dividends such as expanded choices, more specialists, no insurance hassle, greater geographic accessibility and possibly a better fit with your therapist which may enrich or expedite your success. 

This business model give you more privacy for your  therapy and  records. Without insurance reimbursement, less information is shared and your therapy records "travel less". Your  “diagnosis” is not required to be shared with managed care/insurance to justify payment of benefits. 

Many expert and experienced mental health professionals have  never accepted or have left managed care and choosing a private pay business model.  If your budget permits and you have discretionary funds for expenses such as  a trainer, yoga instructor, weekly salon visits, high end travel, and such, allow yourself  the possibility of searching from a full list of providers.  Consider not limiting your options to providers who are on the “in-network” list provided by your insurance carrier. 

Investigate and cover all the bases by researching any out-of-network insurance benefits you may have.  Evaluate whether that well-qualified “in-network” therapist you are about to schedule can help you accomplish your goals as well as the well-qualified "out-of-network"/private-pay specialist with whom you sense you have the best fit.

How do providers benefit from a private pay business model?

When mental health providers do not join or opt out of managed care contracts and adopt a “private pay model”, they  safeguard the sustainability of their professional practice. They become less financially vulnerable because, with managed care contracts, providers must accept both the lack of control over business expenses which steadily rise and the lack of control over reimbursement rates which remain flat. The managed care contractual fee schedule is generally standardized, non-negotiable, and typically does not offer a cost of living allowance (COLA) Providers have no voice. 

Additionally, managed care companies have not increased reimbursement for the "added value” of services to clients from  providers with expert specialties/training nor those with extensive years of professional experience and time of service in their own managed care contract network system. Private pay professionals with expertise and lengthy experience may be a “bargain” considering all the factors of choice

What is Dr. Patt’s Policy?

STLEQ and Dr. Patt changed business models and discontinued all managed care company contracts after 25 years of participation. STLEQ adopted a private pay model with the option lower cost pre-paid service bundle  packages for therapy. This business decision was made because of the unfairness of the managed care system and the negative impact that managed care contracts imposed on financial stability and growth of business.

We know that a number of our therapy clients have health insurance  and may prefer to use it. We keep our qualifications up-to-date and have an active listing on the National Provider Index (NPI). This step potentially helps our clients who want to try to utilize their out-of-network benefits for insurance coverage of our counseling services To stay on this list with her NPI number, Dr. Patt  quarterly documents credentials. Your insurance company can go to identify through this nationally recognized resource to verify eligibility of services for coverage. Dr. Patt’s NPI# is 1427 1251 03.

What else might I consider ?      

As financially feasible, consider  re-evaluating  any “economic value mind set” (you may have) that “if my insurance doesn’t pay for his/her services, I shouldn’t go there.”  Ask yourself whether you should shift your budget. Don’t you deserve your top choice for your mental health and well-being? Consider what you may spend  for other optional personal services such as hair care, fitness training, massage, nail salon, and recreational expenses. How does your mental health and wellness stack up as a priority?

NOTE: Here is an additional consideration some may feel important when choosing a mental health provider. When you choose an in-network provider and/or utilize your health insurance benefits coverage for counseling/therapy, you create a medical record for yourself of a mental health diagnosis from the Diagnostic and Statistical Manual of Mental Disorders that the therapist must provide to the insurance. Private Pay treatment does not require does not involve sending a mental health diagnosis anywhere. Decide whether this privacy and control of your records matters to you.

Do I get what I pay for when I pay out-of-pocket for therapy? 

Only you can decide.

With due respect to and an exception for the highly experienced and skilled providers who  continue to participate in managed care contracts (some of whom are my esteemed colleagues), you may "get what you pay for" (or less) when you have limited options of providers when you use managed care for mental health services. In-network provider contracts are also frequently the starting point for licensed providers who are beginning their practices to get established. 

There are distinct reasons clients self-pay for  professional services. You will recognize if any apply to you personally.

• Some clients with insurance self-pay because they want to preserve their privacy. They prefer not to have a mental health service on their medical records with the required mental health diagnosis. This is the choice of a number of people who consider themselves in “sensitive” positions—personal or employment.
• Others are unable to find skilled, highly qualified, and well- experienced providers listed in their insurance networks who meet their needs and with whom they feel they have a “fit”. They make it a priority to use discretionary funds for their important mental health and wellness needs. Instead of spending those dollars elsewhere, clients choose Dr. Patt’s professional services and self-pay.
•  Clients who research many therapists before selecting one, often find that great credentials, lengthy experience, and unique approach to be “just-the-right fit” for them. The question of insurance reimbursement becomes a secondary concern or not a consideration at all. High quality professionalism and that “fit” are their top criteria to take care of their mental health and wellness needs.

In addition, Dr. Patt feels honored that her clients, family, friends, and colleagues often refer their family, friends, and co-workers to her for counseling services. The strength of their referrals makes insurance reimbursement a “non-issue” for those they refer to Dr. Patt.

Why do clients pay out-of-pocket for Dr. Patt’s services?

Many former clients who came to Dr. Patt and paid only a co-pay when she was an in-network managed care insurance contractor returned for her services. They self-pay and  explain why they do. Paraphrasing, here are the frequent reasons offered: **

• We have a great fit.
• Many counselors I tried  in my insurance seldom talked much. They only listened and asked how I felt.
• I found that you often get what you pay for.
• I learned more from Dr. Patt in one session than I did from others in many visits.
• Dr. Patt helped me think of things in ways I never had before.
• When Dr. Patt dropped managed care insurance, I stopped coming to her because I wanted to save money. I saw several providers in my insurance plan  for my $25 co-pay but did not accomplish anything with them.  I am back to see her. Dr. Patt is worth the money.
• Dr. Patt is sensitive, funny, and gets right to the point

 ** Past results are not a guarantee of future results.

1. If possible, get a recommendation from someone you trust.

2. Research available practitioners online and on your in-network insurance list.

3. Select 3-8 appropriate candidates, a mix of both in- and out-of-network, and private pay.

4. Identify your values and priorities among the factors listed above and other qualities of importance for you.

5. Weigh for yourself the importance of the "privacy/records control" issue of having/not having a "mental disorder" diagnosis on your insurance health record.

6. Carefully evaluate and compare the factors relative to your preferred candidates.

7. Prepare a handful of questions.

8. Contact the 3-5 top therapists you have in mind and briefly interview him/her with your questions.

9. If necessary, balance any budgetary considerations about choosing an out-of-network/private-pay provider.

10. Make a choice and set an appointment.

A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset for managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include: 

• Attaining a better understanding of yourself, your goals, and values.
• Developing skills for improving your relationships.
• Finding resolution to the issues or concerns that led you to seek therapy
• Learning new ways to cope with stress and anxiety
• Managing anger, grief, depression, and other emotional pressures
• Improving communications and listening skills
• Changing old behavior patterns and developing new ones
• Discovering new ways to solve problems in your family or marriage
• Improving your self-esteem and boosting self-confidence

Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you've faced, there's nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. 

You are taking responsibility by accepting where you're at in life and making a commitment to change the situation by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face. 

People have many different motivations for coming to therapy.   Some may be going through a major life transition (unemployment, divorce, new job, etc.), or are not handling stressful circumstances well.  Some people need assistance managing a range of other issues such as low self-esteem, depression, anxiety, addictions, relationship problems, spiritual conflicts, and creative blocks.  

Therapy can help provide some much needed encouragement and help with skills to get them through these periods.  Others may be at a point where they are ready to learn more about themselves or want to be more effective with their goals in life.   In short, people seeking psychotherapy are ready to meet the challenges in their lives and ready to make changes in their lives. 

Because each person has different issues and goals for therapy, therapy will be different depending on the individual.  In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session.  Depending on your specific needs, therapy can be short-term, for a specific issue, or longer-term, to deal with more difficult patterns or your desire for more personal development.  Either way, it is most common to schedule regular sessions with your therapist (usually weekly).

It is important to understand that you will get more results from therapy if you actively participate in the process.  The ultimate purpose of therapy is to help you bring what you learn in session back into your life.  Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process - such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their lives.   

Confidentiality is one of the most important components between a client and therapist/counselor. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but the therapist's office.   Every therapist should provide a written copy of their confidential disclosure agreement, and you can expect that what you discuss in session will not be shared with anyone.  This is called “Informed Consent”.  Sometimes, however, you may want your therapist to share information or give an update to someone on your healthcare team (your Physician, Naturopath, Attorney), but by law your therapist cannot release this information without obtaining your written permission.

However, state law and professional ethics require therapists to maintain confidentiality except for the following situations:

* Suspected past or present abuse or neglect of children, adults, and elders to the authorities, including Child Protection and law enforcement, based on information provided by the client or collateral sources.

* If the therapist has reason to suspect the client is seriously in danger of harming themselves or has threated to harm another person.