Why My Private Counseling Practice Does Not Take Health Insurance

Do no harm.

People’s health care records accompany them for life. Given that substance use is stigmatized and criminalized, I urge anyone with a substance use concern or an addiction issue to self-pay if they can so no third parties – including health insurance companies – are notified.

In private practice as a direct-pay, independent counselor, I keep clinical notes that can only be accessed with a client’s release or if the records are subpoenaed for use in legal matters. I write notes to meet professional and ethical standards but they carefully include minimal details. I do my best to help protect my clients’ human rights.

Doors can close with a diagnosis related to addiction of any kind. Opportunities – invitations to join in, scholarships, employment, promotions – can be denied because most do not understand – or refuse to acknowledge – that addiction is a very human, treatable condition.

(Since my health care record includes an alcohol use disorder diagnosis, even though I have been in remission 7 years, I assume I will not be allowed painkillers if I’m ever in an accident and taken to an E.R. Denial of medication to people with current and former issues with addiction is tragically sad and life-threateningly dangerous, but I’ve seen it too many times locally and it’s a noted nationwide phenomenon.)

I provide individualized, responsive, comprehensive services not covered by health insurance.

Substance use disorders, challenging behaviors, and the mental illnesses that may accompany them can be complex, on-going conditions that may not remit through medical care and individual and group counseling alone. Comprehensive assistance is needed. My fees for individual and group counseling sessions include case management services, within-24-hour replies to texts, phone calls, and emails, contingency management awards, and custom-created, individualized readings, materials, and activities. These services are not reimbursed by health insurance companies.

I offer evidence-based care.

Health insurance companies specify what treatments will be reimbursed and can deny coverage for research-backed treatment. I keep abreast of the latest research on treatment for addiction. Today, right now, I can offer the very best care suggested by research that I am qualified to provide. (Medical care is the first line of treatment for addiction and may be sufficient. I am not a medical care provider.)

Clients and I are free to co-create individualized, evidence-based treatment plans designed specially for them to include the components and pacing that fit their specific needs.

I am here to help.

If I were to take reimbursement for services from health insurance companies, I would be obligated, under contract, to charge agreed-upon fees. I would commit a billing violation if I offered a sliding scale or discounted fees for low-income or no-income individuals. I have a small practice and can only offer a limited number of scholarships. I am honored and gratified that they are filled. I respect contracts and do not enter ones that compromise my ability to be of service to those in need.

Time is finite and precious.

I am 61 years old. I respect the protective intent of the vast amounts of information required to provide services covered by health insurance. I am passionate about clients and this work. I choose to spend my remaining time on the planet serving clients, not completing forms.

If the way I offer counseling services is a fit for you, please contact me. I would welcome the opportunity to work with you.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Let’s Dance

I invite you to dance in 2020.

In a bio for one of her early articles – which I can no longer find but she corroborates – neuroscience journalist Maia Szalavitz wrote that she attempts to live an evidence-based life. I do, too. I try to use the findings of research – which are simply meticulous attempts to discover and express cause-and-effect relationships – to open my life to what’s real and possible.

Anne dancingThe evidence is in on dancing. I’ve added it to what a lovely friend terms my “carefully crafted” life. I invite you to join me.

Here’s why.

Loneliness, social isolation, and lack of social relationships are increasing in the U.S., are linked to cognitive decline, and contribute to premature death. Former Surgeon General, Dr. Vivek Murthy, termed this a loneliness epidemic. This writer elaborates in The New York Times. Forty percent of Americans identify as lonely.

If loneliness is the problem, the logical solution is to find something to do with people.

For many, that something needs to be engaging enough to add to a long day of effort at work or home. It needs to take little time, be learned quickly, and have low costs.

Dancing can meet those criteria. And research on dancing suggests it helps with more than loneliness.

  • According to this 2016 report, “Results suggest that participation in partnered dance styles is associated with perceived improvements in physical fitness, cognitive functioning, social functioning, mood, and self-confidence, and that perceived benefits may increase as individuals dance more frequently and over longer periods of time.”
  • According to this 2018 brain imaging study, “Our results indicated that ballroom dancers showed elevated neural activity in sensorimotor regions relative to novices and functional alterations in frontal-temporal and frontal-parietal connectivity, which may reflect specific training experience related to ballroom dancing, including high-capacity action perception, attentional control, and movement adjustment.”
  • According to this clinical trial conducted in Greece in 2017, “Dance may be an important nonpharmacological approach that can benefit cognitive functions.”
  • According Dr. Agnieszka Burzynska, quoted in the 2017 New York Times article, “Walk, Stretch or Dance? Dancing May Be Best for the Brain, “‘Any activities involving moving and socializing’…might perk up mental abilities in aging brains.”
  • In this 2017 study comparing recreational ballroom dancers vs. non-dancers, “heightened cardiovascular functional status” was observed in the dancers.
  • According to this 2019 report, “This study validates the intensity of recreational ballroom dance as matching the criteria established by the American College of Sports Medicine for improving cardiorespiratory fitness and reducing the risk of chronic diseases.”

Look at all the reasons to dance! I glory in reasons! But, I can hear the voice of Deborah Richey, executive director of Sapphire Ballroom, laughingly chiding me: “Anne! Dancing is fun!”

Yes! It is fun! I love to dance!

Here are some drop-in opportunities to dance in the New River Valley of Virginia (in alphabetical order). Please follow the link to check the schedule.

I took myself to my town’s rec center for my first dance lesson in April of last year at age 60. I felt uneasy openly revealing to people I didn’t know my lack of skill and lack of a partner. Our instructor briskly asked us to decide if we wanted to “lead” or “follow,” then walked us through beginning steps until we had them. Then she asked us to dance with the person in front of us. Then to shift and dance with the next person!

In my decades as a teacher and a student, I have never before witnessed such skilled, efficient, effective instruction. In one hour, a room full of uneasy, awkward strangers were transformed, laughing and spinning to the music together. We were dancers.

Beyond Dance Etiquette: Success and Enjoyment in Social Dancing by Professor Aria Nosratinia, at over 20 years old, is the most uplifting, encouraging, realistic writing about partnership dancing I have yet read.

I so hope to dance with you in 2020!

Photo of Anne Giles by Sapphire Ballroom at the West Coast Swing workshop by Adela + Eddie.

Last updated 1/19/20

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Suggestions for Parents and Partners

If your loved one is receiving medical care and evidence-based counseling for addiction, you have implemented two of the trio of care components recommended by science: medical care, counseling, and support.

To support your loved one, following these suggestions may be helpful.

1) Offer love, evidence-based care, and respect as guided by Maia Szalavitz, neuroscience journalist and author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction.
What fights addiction? Love, evidence, respect

2) Seek counseling for yourself. Having a loved one with addiction can be traumatizing. Preventing traumatic experiences from deepening into trauma disorders can depend on how you are treated and how you treat yourself. Avoidance beckons but ultimately harms rather than helps. Guidance from professionals trained in trauma recovery can help you approach and deal with the realities of your particular situation.

3) Counteract your loved one’s internalized stigma and fight society’s stigmatization of addiction by using only science-based terms in reference to your loved one’s condition Although focused primarily on substance use disorders, consider consulting Changing the Narrative, a guide to using accurate language about addiction from the Health in Justice Action Lab at Northeastern University.

4) Take care to avoid attributing the presence of addiction to personal, moral, or character traits. That is not accurate, causes setbacks, and does harm. Although the origins and functioning of addiction in each individual’s brain are complex and unique, at essence, addiction is the performance of over-learned behavior without thought (often termed “brain automaticity“) despite negative consequences. With the assistance of medical care – including, perhaps, medications – counseling, and support, the individual may be able to become conscious of the learned process and alter it.

For more suggestions, please consider:

If I can be of service in any way, please do not hesitate to contact me.

With regard to opioid use disorder

Last updated 1/16/20

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Self-Soothing Statements for the Human Condition

People can be burdened with two fundamental, often unconscious, beliefs: “I am a bad person” and “I am an incapable person.” As global statements, they are untrue. Only a very few of us can be perceived as evil, lacking such empathy that we take action without thought of human consequence. The rest of us, as humans, have brains that have evolved for us to be primarily good to each other, if only for survival reasons. Even if we make mistakes often – which, again, most of us don’t or we wouldn’t survive – we don’t make them all of the time.

The troubling nature of these beliefs is multiplied when they are paired with the just-world belief.

“The just-world belief holds that good things happen to good people, that bad things happen to bad people, and that the world should be a fair and just place. This belief emanates from the desire to find an orderly, cause-effect association between an individual’s behavior and the consequences of that behavior…this is a hard-wired, evolutionary need of humans to predict and control events in order to survive.” (65)
– Resick, et al., Cognitive Processing Therapy for PTSD: A Comprehensive Manual, 2017.

Anne's ringLook at the permutations of thoughts that can arise from the “I am bad”/”I do badly”/just-world belief scenario:

  • Something good happened. I must have done something right and deserve credit.
  • Something bad happened. I must have done something wrong, I am to blame, and I deserve punishment.
  • If I had just done something different, this bad thing wouldn’t have happened.
  • If ________ had only done something else, this wouldn’t have happened. (“hindsight bias”)
  • If I just could figure out what would have made a difference, I would feel more certain about why it happened and I would feel better.
  • If I do this and say this, and don’t do that and don’t say that, I can keep bad things from happening.
  • Why me?
  • Why not me? (“survivor guilt”)

A few weeks ago, one or more people came into my home, ascended the stairs to my bedroom, opened my jewelry box, and took a selection of rings, primarily the most valuable and beautiful. I experienced very human shock, fear, and grief. But part of the human condition is having things we love taken from us. Adaptively, we usually grieve, practice self-care, seek out and receive support, accept sad, unfortunate facts, and move ahead.

Instead, I descended into a hell of suffering. I had the experience of watching myself slip and tumble, being baffled by how this was happening, but being unable to do anything about it. Finding life enriched by giving and receiving counseling, I sought care from my in-person counselor and from online counseling via Talkspace. I worked and worked to become aware of my primary and secondary feelings, to sort through my thoughts as facts vs. beliefs, and to access my inner wisdom for guidance. (That’s the essence of the counseling protocols CBT, DBT, and CPT rolled into one.)

I think realizations usually dawn on people, but I actually had a eureka moment. On Thanksgiving, I worked out at my gym, then spent the rest of the day alone. In a moment of deep reflection, I realized I was thinking, “If I were a better, more capable person, this wouldn’t have happened. I should be better and I should have done better. Shame on me.”

Good grief! Who wouldn’t suffer from being told these things?! And in my own head! I had no idea how mean I was being to myself! No wonder I was suffering!

It is the human condition to think thoughts like these. But it is within our human capability to transform them.

I was asked by my Talkspace therapist, “What feelings are you trying not to feel?”

Repeating those beliefs to myself helped me avoid the fact I reject most often – “I am helpless to change what happened” – and the feeling I reject most often: sorrow.

For helpless sorrow, there is only one human, humane response: self-soothing statements of kindness.

  • Some things happen for no discernible reason.
  • Some things happen to me – both good and bad – that have nothing to do with me, who I am, or what I’ve done.
  • Some things happen to other people – both good and bad – that have nothing to do with them, who they are, or what they’ve done.
  • Some things happen that cannot have been predicted, prevented, or controlled.
  • For some things that happen, an alternative action may have had an equally negative or worse outcome.
  • I know this is a difficult time for me.
  • I am so sorry I’m going through this.
  • This is hard.
  • I’ve been through hard things before and I made it. I can make it this time, too.
  • I am here for me.
  • I am not going to leave me.
  • I have the skills I need to take care of myself. I can ask for help from others when I need it.
  • I can comfort myself.
  • I can help myself through this.
  • I can help myself do what I need to do.
  • I can care for myself.
  • I have hope for myself and wish the very best for myself.
  • Above all, I am kind to myself.

Image is an enlargement of a photo taken in 2007 of one of my missing rings: 14 karat gold, heavy band; oval pink tourmaline, estimated 9 x 6 mm; small diamond on either side of stone; scrollwork wire around setting of stone; custom designed by Virginia artist Kirk ______ (unknown last name).

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Evidence-Based Care for Substance Use Disorders: Year 1 Outcomes

After a year of providing evidence-based counseling and case management services to people with substance use disorders and co-occurring mental disorders in the New River Valley and Roanoke Valley of Virginia, I wanted to share my outcome data with you.

For context, to protect clients’ privacy, I have a direct-pay private practice. I currently limit my caseload to 20 clients. My results are reported from a case study level, not a research data level. There was no random selection and no control group. Data analysis is limited by the reports offered by my electronic health record, analysis by hand rather than with software, and by my limited human power to follow up with clients after termination. Enrollment is open and data is based on clinical observations and client self-reports. I count all clients who enroll, not just those who continue.

Since the defining symptom of substance use disorder is persistence in use despite negative consequences, my primary criterion for measuring treatment success is the absence of negative consequences. Conducting urine drug screens can cause harm, toxicology reports are frequently false – even up to 20% – and performing them as a counselor may constitute violation of the American Counseling Association’s Code of Ethics. For those taking medication for opioid use disorder, urine drug screens are not associated with health outcomes. I do not perform urine drug screens.

From October 1, 2018 through October 1, 2019, I enrolled 56 clients.

  • 7% no-showed for the first appointment. In addiction treatment settings, the no-show rate can range from 29% to 42%. (Molfenter, 2013)
  • 20% did not return for a second appointment. In addiction treatment settings, rates for not returning for a second appointment can range from 15% to 50%. (Molfenter, 2013)
  • 73% attended from 2 to 150 individual, group, partner, and/or family sessions.
  • Of the 73% who continued in treatment, 72% have experienced no additional negative legal, employment, educational, and/or health consequences since beginning receipt of evidence-based treatment.
  • Of the 73% who continued in treatment, 34% enrolled in Cognitive Processing Therapy (CPT) for relief from trauma symptoms. 70% of people with substance use disorders have experienced trauma. ((Khoury, 2010) I am trained in CPT, a protocol for PTSD recommended by the American Psychological Association and the Veterans Administration.
  • 67% of the clients with severe substance use disorders who opted to – rather than attend residential treatment – remain in situ and engage in the trio of recommended evidence-based treatment protocols -1) medical care, 2) counseling with cognitive behavior therapy, motivational interviewing, and contingency management, and 3) social support – have been in remission for 6 months or more. Return to active use rates after exiting rehab can be 70% or more.

I welcome speaking with groups or organizations about this work. If I can be of service to you in anyway, please do not hesitate to contact me.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.