Avoiding the Insurance "System"

I worked with a client who had been through a lot and was  interested in seeing a therapist but was afraid of being diagnosed with some “mental illness” that will go on their permanent health record. The client did not feel like there was anything wrong with them at all, but instead just needed a bit of extra support during a difficult time.

The dilemma points to a major problem with the way we think about the work of counselors and therapists. 

The emphasis on diagnosis is a systemic problem that stems largely from the field of psychology trying to imitate the field of medicine. Many insurance companies expect therapists to identify a diagnosis, in the same way doctors do. 

But it’s not the same. Part of the problem is the term “mental health,” and the fact that we tend to think of “mental health” as a personal responsibility. By doing so, we ignore the enormous impacts that our surroundings have on how we feel. Are there times when simple actions we take could positively or negatively affect the way we feel? Absolutely. But in the same way that sometimes people get sick because they are breathing polluted air, or get injured when they are in an accident, people can be made to feel miserable by the culture around them and the things that happen to them. 

On top of that, popular culture tends to assume that being “mentally healthy” means feeling good most of the time. I think that’s not just wrong, but ridiculous. That definition of healthy would mean that a person who is bullied at school should just stop feeling so awful. It would mean that women in Afghanistan would only be mentally healthy if they started feeling good about living under Taliban rule. Other people find it is more stressful to try to be happy than it is to live with some sadness or discomfort. We should respect their wishes, not pathologize them. (If you are one of those people, you are not alone!)

We need to find language to replace the terms “mental health” and “mental illness.” A therapist helps a person respond to a set of circumstances and problems in their life. That is not the same as being healthy or ill. 

The short answer to avoiding a diagnosis is to avoid the insurance system. While not all insurance companies require a diagnosis in order to reimburse for mental health services, many of them do. Unfortunately, avoiding the insurance system can make therapy unaffordable for many people, and that is a real flaw in our system (yet one more example of systems that cause people problems).