[Lola5]

I've been seeing a CBT therapist for over a year to help with my anxiety. Sadly, I have made no progress and my anxiety has only escalated. I trust and really like my T.

Recently, he told me that the key for me might be an IOP (Intensive Outpaitent Therapy). He recommended a place 4 hours from my house. It would be 3-6 hours a day for 3-5 days a week. It is about 2 months. It would be CBT and exposure.

The kicker is that the program would cost be over $20,000. I would need to take out another loan (if I could get one) or borrow money somehow because that is more than my yearly salary.

My other concern is that I suck at doing the assignments my T gives me. He'll tell me to log my thoughts to identify thinking traps. Then, outside of session, I won't do it because I'm so paralyzed by anxiety that it all seems hopeless and that it won't work for me. Then, I'm also overwhelmed by all my obligations with school, work and family so I can't find time to do them.

My T's argument for an IOP is that intensive treatment could kick-start my recovery and all me to work on things that we can't get to in a 45 min session, like exposures. He says it will also save me the money I would spend on seeing him since such intensive therapy can speed up things and would result in me having to see him for less sessions afterwards.

Has anyone had experience with an IOP? Has it helped? Should I stake all this money on it if I'm unsure? Any advice would be appreciated.

Doesn't your insurance cover it, at least partially?

[Nammu]

The oops I attended were very helpful but insurance covered them. Ask your t to help petition your insurance to cover it as a nessary treatment.

[Lola5]

Originally Posted by Breadfish

Doesn't your insurance cover it, at least partially?

No It's out-of-network and I have no out-of-network benefits.

The insurance only covers several in a 200 mile radius and most are for children/adolescents. The few for adults (my T and I reached out to them) were sketchy or said they didn't handle anxiety patients or only focused on substance abuse.

[ElectricManatee]

How would you be able to attend so often if it's so far away from home? Money aside, that sounds logistically complicated.

[Lola5]

Originally Posted by ElectricManatee

How would you be able to attend so often if it's so far away from home? Money aside, that sounds logistically complicated.

It is, but I'm willing to make the commute if it gets me some help. I'd have to cut down my working hours and possibly my course load and try to get them to put as many hours as possible into the fewest number of days.

[88Butterfly88]

I recently made a thread about IOPs. Maybe you want to see what others said.

https://forums.psychcentral.com/hosp...-question.html

Originally Posted by Lola5

No It's out-of-network and I have no out-of-network benefits.

The insurance only covers several in a 200 mile radius and most are for children/adolescents. The few for adults (my T and I reached out to them) were sketchy or said they didn't handle anxiety patients or only focused on substance abuse.

I'm no expert, but can't you claim that as there are no in-network facilities, the insurance company has to cover what would normally be out-of-network?

Not sure if that works if your only problem with some of them is that they're sketchy, though.. (I don't mean to say you're incorrect - just that it's easier for an insurance company to refute)

[Lola5]

Originally Posted by Breadfish

I'm no expert, but can't you claim that as there are no in-network facilities, the insurance company has to cover what would normally be out-of-network?

Not sure if that works if your only problem with some of them is that they're sketchy, though.. (I don't mean to say you're incorrect - just that it's easier for an insurance company to refute)

Yeah, my insurance isn't open to covering out-of-network because those "sketchy" programs are available. My issue with these programs is that they are mostly working with doctoral students or post-docs who are then supervised by a PhD. A few were unable to tell me exactly how the program would work. My T got similar results talking to them. They don't seem to have their act together and/or are poorly organized.

And you want a program that's run by a PhD directly?

[Sunflower123]

I've been through IOP twice now. It at a local mental health facility. It was covered by insurance and it was very helpful. It helped me avoid going IP. I don't know that I would pay $20,000 for a program or for one that is located that far away.

[here today]

I paid $15,000 for one out of pocket but I was desperate. It alleviated the sense of desperation some but I got nothing substantive out of the program per se. Still, I was somewhat better at getting out of the house and being with people after that, so who knows? As desperate as I was at the time, yeah, I felt like I had to do something. Do I think it helped more than as a relatively safe place to force myself to be with other people, no.

I now believe that one of the reasons I was so desperate was because of ineffective and retraumatizing therapy. Nevertheless, for whatever reason, at that point I needed something more than what my therapist was providing, or that any therapist at that point, I believe, could provide.

[Lola5]

Originally Posted by Breadfish

And you want a program that's run by a PhD directly?

I'd prefer working with a PhD and not someone in graduate school or who just graduated. My problems are so severe that I feel like it would be better to have someone experienced.

The real turn-off for those programs was how disorganized they were and unclear about how the treatment would progress. From talking to them, my T said it seemed like these were therapists who decided to run IOPs out of their offices, but were not equipped to do so.

[Daisy Dead Petals]

How does your T account for your lack of progress? Learning to manage anxiety can take a long time, but to find that your anxiety had actually increased after a year of therapy could indicate a bad fit between you and your therapist. You like your T, but is he effective at his job? Therapists aren't always great at admitting they don't know how to help.

Are you satisfied with your diagnosis? I wonder if you have a comorbid condition that is not being addressed. You may also want to consider if CBT is the right therapy for you. If you're struggling with your assignments now, how will more of the same help you?

[itisnt]

Nope, I'm a person who doesn't advocate any therapeutic intervention that requires a person to take out a loan or run up their credit card. I'm not saying that there aren't some individuals who have benefited from that kind of situations, but most find themselves even more stressed by the resulting financial obligations. Just consider how many "non-therapy" people who are in-debt who then find themselves overwhelmed by the "pay back" requirements of their programs and find themselves no better or only marginally better when they borrowed the money for a program that isn't able to guarantee the results of their stated goals!

When I was hospitalized for a serious situation over ten years ago, the discharging psychiatrist recommended an excellent program across the lake from my place of residence. It was EXPENSIVE and my insurance would not even consider covering the cost. It was 5 days a week from 9:00 to 5:00 pm. The program was run by highly qualified professionals and it had an excellent success rate; it had glowing recommendations from its "graduates'. BUT it would have cost me over 50,000 for a year of treatment. Hey, I'm not ignorant, I knew that that was a "deal" when factored into what was going on in my life at the time, but the reality was, I couldn't afford it and I wasn't about to take out a loan to finance it! I had a GOOD professional job and if I got myself together enough to return to the place, they'd accept me back. I took three months off, got some good solid individual therapy and then returned to work. . .. without the life crushing loan that the treatment program would have required. Was I "all better". No. I still struggled and I still struggle to this day, over ten years later, but things aren't even worse because I'm trying to pay back an IMPOSSIBE therapy loan that isn't going to make my life all "rainbows and unicorns!"

I talked to people who were in the program. They were wealthy people! They had family with money to pay the tuition or they themselves had money. They were good people but they were also people who had the opportunities that I didn't have. I wasn't someone who was poor or disadvantaged. I had great insurance! But I didn't have the kind of insurance that paid for Cadillac services. I don't begrudge that. I had the type of insurance that paid for hospitalization, medication and regular counseling--I just didn't have the type of insurance that could or would pay for services that were daily intensive and based on manualized treatment. The only way these intensive treatment programs can survive is by refusing most insurance plans and seeking out private pay. . . in other words, private, rich money reimbursement. Most of us don't have that option.

Sorry for being so sarcastic about the money, but I truly believe that the therapy "profession" can be a real soul sucking, money grubbing, clueless to the needs of everyday citizens when it comes to making people's lives better. I really hope you're able to find the right treatment for you needs!

[growlycat]

Great post above. These issues have kept my mom from addiction treatment centers bbecause insurance does not pay and the whole family combined cannot afford to send her even if she would go.

I would be very wary of going into debt for a program that is not only temporary but you don't know if it will help. I would exhaust all other options first

That is a lot of debt if this doesn't pan out the way your therapist expects it to. If I decided to take out a loan for therapy/hospitals it would be to do intensive therapy individually or as an inpatient which would take me away from other stressors to focus solely on healing. The program your therapist suggest doesn't do that, and the commute would make it intolerable for me.

I would have my doctors hound my insurance company and appeal each time denied or I would even try with a sketchy one, but would never take out "another" loan.

ETA: Many of the people that pay out of pocket for these programs go three or more times and don't always make the progress that their doctors, family and they themselves expected.

I agree with Itisnt and Attachments Bueno that I don't think it would be helpful to go into debt for this program, I think in the long run that would cause you greater stress. I don't know if you have tried another therapist? I think there are a number of people on this board who have found switching therapists to be helpful. I myself found it a hard thing to do as I was attached to my T's, but I'm finding my third T to be much more helpful than the first two. I feel different now.

The program you speak of seems to be using clients to train therapists and get research publishe/dissertations. (Maybe they should pay you and not the other way around.) With the options available, I would give it a try and not go back after a couple of days if not satisfactory.

Wouldn't you also have to pay for a hotel? Why did your T recommend that place?

I don't know much about these types of programs but wanted to ask you if you ever considered that maybe your anxiety is from ADD?

[Lola5]

Originally Posted by Daisy Dead Petals

How does your T account for your lack of progress? Learning to manage anxiety can take a long time, but to find that your anxiety had actually increased after a year of therapy could indicate a bad fit between you and your therapist. You like your T, but is he effective at his job? Therapists aren't always great at admitting they don't know how to help.

Are you satisfied with your diagnosis? I wonder if you have a comorbid condition that is not being addressed. You may also want to consider if CBT is the right therapy for you. If you're struggling with your assignments now, how will more of the same help you?

I feel like my therapist understands me and it took me forever for me to find someone I could relate to. My T thinks that it's a combination of work/school and not having the right meds that has caused me to get worse.

I've only ever been formally diagnosed with anxiety. Sometimes I've been told I have hints of PTSD. It seems like every doctor (mental and non-mental health related) has told me I need to do CBT and that is what will help with my anxiety.

I feel like it's something wrong with me that I'm not able to benefit from a therapy that helps others with my condition.

Originally Posted by itisnt

Sorry for being so sarcastic about the money, but I truly believe that the therapy "profession" can be a real soul sucking, money grubbing, clueless to the needs of everyday citizens when it comes to making people's lives better. I really hope you're able to find the right treatment for you needs!

I understand your viewpoint. I've had this fear and distrust as I'm shelling out money that what if the mental health professional is just trying to get money out of me and isn't really trying to help. I fear that with this program. I think I trust my T though that he is not just taking money from me and actually wants to help.

Originally Posted by Brown Owl

I don't know if you have tried another therapist? I think there are a number of people on this board who have found switching therapists to be helpful. I myself found it a hard thing to do as I was attached to my T's, but I'm finding my third T to be much more helpful than the first two. I feel different now.

I am so scared of this. It took me years to go back to therapy after being traumatized by a harmful T. I feel like this one is actually interested in helping.

Originally Posted by Blanche_

Wouldn't you also have to pay for a hotel? Why did your T recommend that place?

I don't know much about these types of programs but wanted to ask you if you ever considered that maybe your anxiety is from ADD?

My T said that this place is well-known and has a good track record. It is target specifically to anxiety and CBT. It's the only one like this that is remotely close to me.

I've had neuropsych testing and they ruled out ADD. I've always wondered though about this.