45 minutes not long enough

[Lost]

Mine says, "Ok... We have to finish now" in the exact same tone of voice every time...

 

[David Baxter PhD]

You could always broach the subject by remaining seated when he stands up and just saying, "Leg cramp?"

 

[Peanut]

LOL!! I'll try that one out on him and let you know how it goes! Maybe it will buy me a couple extra minutes

 

[Peanut]

Well today, instead of addressing the early session ending directly, I decided (on the spur of the moment) to kick it up a notch and be a little more interesting.? Well, it totally worked.? My session went on for 50 MINUTES!!!! And it seemed like he was going to keep going, but at the 50 minute mark I decided to end it and stood up and said "Well, it looks like our time is up for today" and then I left.? I just can't believe that I was right all along...being more interesting was what it took to get a long session! :shock:

 

[Eunoia]

toeless, I hardly doubt you're boring your therapist like you said... if a therapist were that easily bored after so few sessions then I would take a close look at the therapist as a start... I think it sounds like "being interesting" isn't necessarily a lack of you being interesting in the previous sessions, but more a reflection of how comfortable or willing you were to open about things in your life... which is totally understandable, it's difficult to tell someone things you've been keeping inside or things not many people know etc. well, I'm happy you got your 50min! I find that time goes by INCREDIBLY fast during sessions, even if there's so many other "major" or "interesting" things we haven't even touched on- so I guess it does make sense to bring something up if you want to adress it and it sounds like your therapist definitely wants that input from you too. if you want to talk about smoking then you tell him that- I kind of disregarded a few things at first myself, only to realize later that there was more to say about them- but if I wouldnt' have mentioned them again they would have been left on the side for now- so I understand where you're coming from, but I do think it's important you get to talk about what you feel is important to you. after all, it's about YOUR life, right?

 

[Peanut]

Yes, you're probably right, maybe what I interpeted as more interesting was just more forthcoming. The session was lots of fun. It felt much more exciting to me. And it was also interesting because he gave me his "clinical impression" which was that I had substance abuse problems, low self confidence, and anxiety with perfectionism that is related to the OCD that I used to have. So I felt like I gained quite a bit of information. Apparently he was using the previous sessions to create an accurate picture. Now he told me to think this week if I'm willing to try not taking certain substances (not pot). I'm not sure though, that if I'm not ready to decide that, if that is the end of his scope or if he will still see me. I don't know why I never think of these questions while I'm there.

 

[Cat Dancer]

I don't know why I never think of these questions while I'm there.

Maybe you could write down a few of these questions during the week and take that with you?

 

[Eunoia]

in a way it's weird to hear that "clinical impression" but on the other hand I think it can also validate a lot of things- put a "name" to everything so to say... if he would have given you this feedback within the 1st 10 min after you meeting him it would have likely not meant a lot to you at all, right? it's a good thing that he waited and used those past sessions to put everything together, paint himself a picture of who you are, where you're coming from, that kind of thing... I don't think he is giving you an ultimatum- personally, I don't think there'd be much use in that in the first place, but if he didn't specifically mention that it was an either or thing, take it for what it is: just a question to see how you feel about making a few changes, working on giving up a few things... letting go of familiar coping mechanisms. You said that he asked whether you were willing to try- that means you do have a choice in it and all you have to do is give it some thought. if you don't feel you're ready to make that decision you could discuss this w/ him instead of just saying "no"- I think on some level you are b/c you're in therapy but there's a big difference btwn being willing to consider making changes and actually seriously working on making changes... I think Janet has a good point- write down things that come up in between sessions and bring them up the next time...

 

[Peanut]

Yes, I agree.? The reason I don't write it down (even though I should) is because it feels like writing something like that down is 1)admitting to the full gravity of the situation in writing and 2)Writing it down and running the risk of having it found.? Sometimes even writing stuff in this forum makes me nervous-even if it is somewhat anonymous.

But!!! The plot thickens.? Today I got this letter in the mail for the insurance company.? It was a cc of the letter they sent my psych, saying something to the effect that the "treatment plan" that was submitted by the doc was approved for 20 sessions during this 6 month period and beyond that they need to be preauthorized (I thought I had 36 no questions asked?).? So now I'm wondering what the heck he sent the insurance company that I get such a weird letter.? I never need pre-authorization for anything.? Maybe that's why he chose to share his "clinical impression" with me at this particular juncture in time-because he just shared it with the insurance company too.

I agree with what you said about the hearing the clinical impression being a good thing. But it's still really hard for me to believe that he's right. A big part of me thinks that, and I know this is stupid, he is just not privy to what everyone else is doing and I just happened to admit to it....I know...it's stupid that I keep thinking that.

 

[Cat Dancer]

Yes, I agree.? The reason I don't write it down (even though I should) is because it feels like writing something like that down is 1)admitting to the full gravity of the situation in writing and 2)Writing it down and running the risk of having it found.? Sometimes even writing stuff in this forum makes me nervous-even if it is somewhat anonymous.

I can relate to that. I probably wouldn't write anything down either because of those fears and I sometimes get extremely anxious writing things down here too. Plus, being with someone who actually taped me talking to show me how stupid I sound makes me worry a lot about how I talk even if it is just writing something down. (I'm not saying you sound stupid or anything like that. You make perfect sense.) I just can understand that worry.

Maybe just try to go with the flow in the session? And not worry about the questions that come up later? I don't know.

Anyway, I hope all of it works out for you.

 

[David Baxter PhD]

Today I got this letter in the mail for the insurance company.? It was a cc of the letter they sent my psych, saying something to the effect that the "treatment plan" that was submitted by the doc was approved for 20 sessions during this 6 month period and beyond that they need to be preauthorized (I thought I had 36 no questions asked?).? So now I'm wondering what the heck he sent the insurance company that I get such a weird letter.? I never need pre-authorization for anything.? Maybe that's why he chose to share his "clinical impression" with me at this particular juncture in time-because he just shared it with the insurance company too.

Not necessarily. When I bill an insurance company for the first time on behalf of a client I often get back a generic letter of that kind reminding me of how many hours or sessions are covered by the client's plan. Unless the client signs a release of information (which might be required for a disability claim or something), no information as to diagnosis or anything else about the client can be disclosed to the insurance company.

 

[Peanut]

Janet, thanks for writing that. It was really reassuring to read that other people think about things like that too.? It's funny how reassuring it is knowing other people think the same strange way.? Maybe it's not so strange to think like that after all.? I cant' believe that someone recorded you to show you that you looked stupid ? What happened?? That is outrageous.? I can really feel for you because I HATE listening to myself on a recording.? I ALWAYS think that I sound stupid.? I bet that you didn't really sound stupid at all.? Thanks for your support--there is a wonderful reassuring quality about the way you write and I always like reading your posts.?

Not necessarily. When I bill an insurance company for the first time on behalf of a client I often get back a generic letter of that kind reminding me of how many hours or sessions are covered by the client's plan. Unless the client signs a release of information (which might be required for a disability claim or something), no information as to diagnosis or anything else about the client can be disclosed to the insurance company.

I hope that you are right!! That letter really freaked me out--I felt a little violated when I thought that he had told the insurance company...well...about my highly private information!? I see that I did sign something that said "When you complete an insurance form you are giving permission to share confidential infomation with your ins company to verify your need for services".? Anyhow, I'm really glad to know that this kind of thing is normal and not a mandatory reporting of drug addicts (becuase I don't want to be labeled that and don't think I am one!). I guess my imagination runs away with me sometimes.? I get worked up just thinking about that kind of thing going on my public record.? But it sounds like maybe it hasn't anyway.? Thanks Dr. B.

 

[David Baxter PhD]

I see that I did sign something that said "When you complete an insurance form you are giving permission to share confidential infomation with your insurance company to verify your need for services".

Ask him what exactly that means.

It may mean simply that he is authorized to tell the insurance company that he has seen you. When I had a contract with an EAP firm some years ago, I would get clients to sign such a form but the authorization form stated clearly that the only information they were authorizing for release was the dates of sessions, NOT the reasons for the sessions or any information about the content. There should be no need whatsoever for an insurance carrier to get any more information than the fact that you intended (unless it's a disability claim).

 

[Eunoia]

I have this weird thing w/ not wanting to put a label on anything in regards to myself as well, I guess b/c it makes it "real" once you give it a name- so just as it can validate things it almost feels like it INvalidates things as well... And yes, I worry about people finding things all the time- to the extent of carrying certain notes etc around wherever I go, or trying to hide them somewhere which only leaves me worried until I get back to make sure it's all still there... part of that comes from bad experiences too, like Janet said, where people did find things... so you learn to be cautious. what if you were to write those things on your computer, "lock it" w/ a password (some word programs give you that option) or even writing it as an email and saving it as a draft, and then just b/f your therapy appt. you could go print it out? or you could write point form notes but use different names for things, I've done that.. or not go into the full extent but enought to make you remember what it is that you wanted to say- for example, "therapy appt. at 2 next wed" could be "meet for coffee @2 on the 8th/Wed"... then when you look at it YOU know you're not going for coffee then but anyone else will think thats' what it is (simplified example lol).

 

[Cat Dancer]

Thank you, Toeless, for your kind words. They really mean a lot to me. More than you can know.

My husband taped me once. It WAS humiliating. He said he wouldn't do it again. No one should do something like that to another person I think. It takes away something inside, tears you down into little pieces or something.

I think Eunoia has some good ideas about writing things down.

I agree with Dr. Baxter. There shouldn't be any reason for your insurance company to have much information at all about what happens in your sessions. I think it is also a good idea to ask the therapist what "sharing information" means so that you can put your mind at ease.

 

[Peanut]

Janet, I'm so sorry to hear about your husband doing that.? It really hurts when it's someone close to you that does something like that-someone that your supposed to be able to trust. If it's any consolation I think that he is definitely the one that came off looking stupid doing that, not you at all!?

I think maybe I will take in that letter from the insurance company and ask him what's up with it.? I know that MSW I went to see once sent in a diagnostic code for adjustment disorder.? I saw it before I sent it in.?

So when it says that more visits need pre-authorization, would that be like you (dr.B) had said before, about there first being a provisional diagnosis and then moving to another diagnosis later?

I guess I'll have to wait to talk to him about it for two weeks.? He wants me to come weekly but stupid me keeps not making the appointments in time even though I know that he will book up if I wait.? I always get all bent out of shape and wait a couple days to cool down.? I think I cut off my nose despite my face (I hope that's the saying?! I always get them wrong!).

 

[David Baxter PhD]

when it says that more visits need pre-authorization, would that be like you (dr.B) had said before, about there first being a provisional diagnosis and then moving to another diagnosis later?

Possibly. Some practitioners use the diagnosis "adjustment disorder" as a kind of generic fill-in-the-blanks diagnosis for insurance companies. Requests for additional sessions may or may not require a diagnosis - I'm not sure of the situation in the US but up here it depends on the insurance carrier and how the policy is written.

 

[comfortzone]

Some insurance companies will add more sessions per incident or diagnostic changes (if there are any). For instance, I might see someone for anger management but then it is established that depression or anxiety is also a major component masked by the anger difficulties.

Therapy can appear to be difficult or scary but the process of therapy takes time and not going to therapy leads down a path far more difficult and scary in my opinion. Take care,

 

[Peanut]

So which diagnosis get the most visits (generally)? Anxiety and depression? I bet manifest in a lot of different ways and are at the root of a lot of people's problems. I had a psychologist/teacher tell me once that a really high percentage of health problems are due to the mismanagment of stress.

 

[comfortzone]

It depends upon the circumstances and like you mentioned what is being manifested. Typically, most of the insurance companies set number and then additional eight weeks per incident.