[Lola5]

I spoke with my T about the hesitations I have about an IOP (cost, distance). He is still for the idea of an IOP, but said as an alternative I could see another T he knows who does intensive exposure therapy and is very qualified/multiple accreditations and awards.

This T is only 2 hours away. He is willing to see me 3-4 times a week for 2-3 hours a day to do exposures (which is what my T feels I need). The treatment plan would be for 4-5 weeks. Again, though, money is a factor. This T is out-of-network and charges $500 per hour. The cost would start at $12,000. As usual, the cost is an issue. I'd still need to take out a loan.

I was wondering how possible it is to find another T who would do intensive exposure work with me (several hours a day, several times a week). Maye someone in my insurance or someone who charges less per hour. Is this type of therapy rare? Has anyone had this type of therapy one-on-one with a T?

My T doesn't know of anyone else and doesn't have time in his schedule to do this kind of intensive work with me.

[feileacan]

I don't fully know your situation. I'm in a very intensive treatment myself which is very different from CBT or anything like that though.

I guess what I don't understand is what justifies asking 500$ from a therapy hour, which for 2-3 hours would make 1000-1500$ regardless of accreditations and awards. Are there certain expensive materials involved or what? If the cost is so high, does this therapist give some guarantee to his work, so that if it doesn't work for you, you will be reimbursed most of the cost. Although I can hardly see how he could give you such a guarantee.

What is it that you want to do the exposure therapy about? What are your underlying issues anyway? Could it be possible that all this CBT/DBT/exposure stuff just doesn't work for your issues - they typically don't work well for issues stemming from early relational traumas and stuff like that.

I personally wouldn't take a loan to pay for psychotherapy, especially such a big loan without any guarantees that it pays off. I can't see why this therapy has to cost so much. I mean, insurance or not, 500 per hour sounds really outrageous and I can't imagine how such a cost can be justified.

[Argonautomobile]

Lord, that price seems criminal to me. I would definitely look for someone/something else. I mean, is this really something you can't do on your own/with your current T/ with a "regular' T? My experience with exposure therapy is that you're really doing all the work. I'm not sure how much the T has to offer beyond emotional support/strategies to reduce anxiety. And $500 for that for 2-3 hours for 3-4 days a week seems ridiculous.

[skeksi]

I'd be more apt to do the IOP you've mentioned than this setup, but I wonder if you can't honestly discuss with your T the financial hardship and come up with some other options to try before you get into debt over this. For example, I know your T is not able to do the work he thinks you need; could you find another local T who might be able to see you two or three times a week and thus do something that's more intense than weekly therapy but not as expensive as the other options?

[satsuma]

Maybe this decision partly rests on how much of a disability your anxiety is in your day to day life?
I'm not questioning that anxiety is horrible, I suffer from it myself. But if you're able to somehow push through and work on your career etc., then maybe one day you would get to a place where you had a different insurance that would cover this treatment, or you lived in a different area or state where more was available, or you had more money.

I just think that this is about balancing up the stress your anxiety puts on your life vs the effect of putting yourself into financial stress. Personally I would err on the side of avoiding the loan - unless the anxiety is so disabling that day to day living is impossible - but on the other hand shouldn't the insurance cover it in that case...?

Sorry if this is not helpful!! I'm sure you'll do what you think is best and that's all any of us can do, isn't it?

[ElectricManatee]

I can't really offer an opinion because I don't know enough about your financial and emotional situation, but that just seems like so much money. The strain of going into debt might be counterproductive to your progress in therapy. Have you thought about exploring another school of therapy first? I agree with feileacan that certain approaches work better for some types of problems and not as well for others. Sometimes it's hard to know the roots of a problem, but your lack of progress makes me think it might be worth exploring other kinds of therapy before really committing financially to this approach. I know some therapists see CBT as useful for symptom reduction before using, say, a psychodynamic approach to get at deeper issues. I might be biased, though, because CBT was not terribly helpful for me in the grand scheme of things, even though I really gave it the ol' college try.

[Lola5]

Originally Posted by feileacan

I don't fully know your situation. I'm in a very intensive treatment myself which is very different from CBT or anything like that though.

I guess what I don't understand is what justifies asking 500$ from a therapy hour, which for 2-3 hours would make 1000-1500$ regardless of accreditations and awards. Are there certain expensive materials involved or what? If the cost is so high, does this therapist give some guarantee to his work, so that if it doesn't work for you, you will be reimbursed most of the cost. Although I can hardly see how he could give you such a guarantee.

What is it that you want to do the exposure therapy about? What are your underlying issues anyway? Could it be possible that all this CBT/DBT/exposure stuff just doesn't work for your issues - they typically don't work well for issues stemming from early relational traumas and stuff like that.

I personally wouldn't take a loan to pay for psychotherapy, especially such a big loan without any guarantees that it pays off. I can't see why this therapy has to cost so much. I mean, insurance or not, 500 per hour sounds really outrageous and I can't imagine how such a cost can be justified.

That cost is just what the T's rates are. There are no special materials and no guarantee. It's how much the T charges (probably because he has like 12 Harvard diplomas).

My T and the p-doc I am seeing both suggested my problems require doing exposures. I fear things like talking on the phone, going to the store, riding elevators, using the stove, walking outside alone so they said I need intensive exposures to deal with these kind of problems.

[Lola5]

Originally Posted by skeksi

For example, I know your T is not able to do the work he thinks you need; could you find another local T who might be able to see you two or three times a week and thus do something that's more intense than weekly therapy but not as expensive as the other options?

Originally Posted by Argonautomobile

I mean, is this really something you can't do on your own/with your current T/ with a "regular' T?

My T said this is the only person he knows who can do sessions that last several hours. I guess it's a rare thing and was wondering if anyone was able to receive this kind of treatment from a T, or if searching for someone else is going to fruitless because they'll only do 45 min.

My T keeps saying he would do exposures with me, but the 45 min we have in session is not enough time and he can't offer more.

[Lola5]

Originally Posted by satsuma

Maybe this decision partly rests on how much of a disability your anxiety is in your day to day life?

I guess there's where the issue is. My anxiety is so awful that I wake up in the mornings and middle of the night panicking. I have no appetite and vomit occasionally when I eat because the anxiety is so bad. I am on the verge of flunking out of school and losing my job due to my lack of concentration/ability to do work.

Basically, I'm desperate for help and something that will work. I'm also scared about the money aspect and going into debt for something that will leave me as I was before. I'm really stuck about what to do to get better.

��500 an hour seems to me to be an absurd amount of money to charge someone, even more so for intensive therapy, and to somebody who can't afford it, and when it might not help. If this guy is so good, then I'm surprised he has time in his schedule to do this work with you. He doesn't sound to me to be very compassionate to charge this money.

[Pennster]

I'm sort of assuming from the cost that this person is Manhattan-based? Could you try investigating other options by googling "phobia therapy NYC" or whatever area you are in? Perhaps you might find people up for doing that kind of exposure therapy at a more affordable cost?

[koru_kiwi]

Originally Posted by Lola5

My anxiety is so awful that I wake up in the mornings and middle of the night panicking. I have no appetite and vomit occasionally when I eat because the anxiety is so bad. I am on the verge of flunking out of school and losing my job due to my lack of concentration/ability to do work.

Basically, I'm desperate for help and something that will work. I'm also scared about the money aspect and going into debt for something that will leave me as I was before. I'm really stuck about what to do to get better.

have you considered trying neurofeedback? it can target the root of the cause of the anxiety, a dysregulated amygdala, and help to calm it, along with other symptoms that the anxiety causes.

[kecanoe]

Yikes, that is a lot of money. Maybe the t has time to do intensive with you because his hourly rate is so high!

I have seen a t for 8 hours per week at one time, so it is possible. Most of the cost was covered by my insurance. I think I would do some research on my own to see what else is available.

To find the specialist that I now see, I had to do lots of asking around. I was told by several area Ts and Pdoc that there was only one person in the area that treated my diagnosis. They were wrong-and T3 has been amazingly helpful.

[unaluna]

For that price, why not go IP? It sounds like you have some weird combination of anxiety and anorexia, both making the other condition worse. Maybe IP, they could deal with that.

[dlantern]

Coupled with our CBT is a little know technique that is only used in privileged societies. Not that it is special but once you buy into the artistry if you have the capacity to understand it can be great work for what your agenda is. What I mean by that is why and how is the exposure for and who all else the sessions are ours......Once you find a safe passage for healing climbing out of the fog with a safe therapist it can be wonderful to deal with....We are more on the positive side yes we can get really negative but ultimately we want to be here so if that means downplaying it then so be it.

Regular therapy is hard work. When a former therapist moved far away (4hours drive). I proposed I take the train to get there, explaining that I did not want to have a tough session (I can't remember if I had a 50 minute session or double sessions) and then possibly be unsafe on the road.

The distance is far and you have no idea how you will respond to these sessions. I've never had exposure therapy, but I have had extended sessions for attachment therapy and it could be brutal and I needed hours of extra sleep. There is information in the academic arena regarding the phenomena for extra sleep to process therapy sessions, similar to the amount of sleep a baby needs.

If my financial, work and school situation were similar to yours, I could not in good conscious consider a loan, unless I was pretty sure that my financial situation would be pretty strong and secure in the next three years. I would start by taking a leave of absence from school to cut down on some immediate stress.

Your therapist could help you more by challenging your insurance company if you yourself have already been refused. If your request is refused again, he can submit your case to other professionals for second opinions to send to your insurance company. Or

...by making room in his schedule since it is for a limited time period, even if that includes weekends. He could schedule this into the near future.