If you're having trouble finding a therapist...
If you're having trouble finding mental health help (especially in Portland), you are not alone. I've been receiving calls and emails each day from people looking for a therapist with certain skills, appointment availability, and insurance paneling or ability to bill third parties. Many of my colleagues are in the same boat and those I've talked with feel terrible about it. We got into this business to help people who want help - not to turn them away. So what's going on?
Here are some things I imagine you might be wondering if you're struggling to find a therapist and my best attempts at answering them:
Why don't you notify insurance companies when you become unavailable?
The switches from available to unavailable happen so fast that we can't keep up. A lot of times "open" means we have one or two spots available and when those are filled, we're again closed. Second, a lot of insurance companies really bury that "accepting new patients?" button where it's hard for us to find it. I had to call technical support with one of my carriers to figure out how to switch myself to "unavailable."
I saw your directory listing - it didn't say you weren't accepting new patients.
True. I cancelled one of my directory listings last week and another, I'm trying to figure out where to put "no" on accepting new clients. I did update my voicemail and website but not everyone sees that before calling or emailing. This is a symptom of the same problem above; when you go from closed to open and back again in the course of a week, it's very hard to toggle those available indicators on and off with precision.
My doctor referred me, so you must be open.
These situations are the worst because we're letting not only YOU down, but also the professionals who referred you to us. Full time primary care physicians have panels of up to 2,000 patients at any given time. Full time counselors may have 20-40 patients at any given time, depending on how frequently they're meeting with those clients. Physicians may see 24 patients in a day while counselors see four to six. Assuming that 10% of a physician's practice needs mental health care at any given time (just a guess), a doctor would need five to 10 counselors to meet the demands of a single physician's panel. Unfortunately, there aren't that many mental health practitioners in our community. As we begin to talk more about the importance of mental health care to general health and wellness, we're missing the manpower necessary to meet demand, hence why many practices are full.
What am I supposed to do then?
1. Call a counselor who appears to be open and who appears to meet your needs. If they can't meet your needs, ask them for referrals. Although not every counselor you call can give you personalized help with finding someone open, many counselors can and will. Many counselors also have referral lists.
2. Consider how flexible you can be to come to appointments during regular business hours. Many folks want evening/weekend appointments and there aren't enough to go around. If you can come to counseling during the day, you'll have more options.
3. Consider seeing an intern. Registered Interns in Oregon are qualified mental health practitioners who have graduated from programs, often passed their board exams, and are simply accruing hours toward complete licensure. "Intern" in the title doesn't mean they're not good or qualified. It means they're just earlier in their careers and they may be able to slide lower on cash-pay scales than other fully licensed practitioners.
4. Research your "out of network" insurance benefits. Insurance plans vary considerably in how they cover clinicians who are not paneled with them. When I recently cancelled my contract with an insurance company, I found that many of my clients had out of network benefits that made the cost of seeing me similar to their cost when I was in-network.
5. Look into therapy groups. Therapy groups can be less expensive and more available than individual therapy. Groups may not fully meet your need for personalized individual therapy but they can be surprisingly healing and can at least get you immediate support while you look for a personal therapist.
6. If you have employer-sponsored insurance and feel comfortable enough to share, let your HR department know if your mental health benefit isn't as easy to use as they said it would be. Your HR staff may have been sold a great-sounding plan that isn't actually so great after all. They need that feedback.
Most of all, don't give up
Taking care of your mental health is a lifelong process. You may be most motivated to seek out help when you're in high distress but if that acute distress passes before you find someone to help, don't stop looking. It's easier to get into a practitioner if you've already worked with them in the past. It's also fair to work on your mental health when you're in low to medium distress, so you're practiced when the pressure increases in the future. Stay motivated and make that connection now so you have it in the future.