I’ve tried all kinds of solutions for my symptoms and nothing works.  Why would therapy work for me?

ADHD is a performance issue, not a knowledge issue.  You know what you need to do, you just have a hard time doing it. And while that general tenant is true for most people with ADHD, the exact nature of the performance issue is highly unique and individual. Therapy helps you figure out exactly what gets in your way and come up with ways around those specific difficulties.

How can I have time for therapy when I need to spend so much time on doing the things I need to do?

Therapy will help you work more effectively so that you are not wasting your efforts. You may spend a lot of time procrastinating and avoiding work and so it feels like you need twice as much time to complete a task because you need to take all of that procrastination into account. You may also be doing things that are relaxing, but never feel restored by them because you are always worried about the work you should be doing. Therapy will allow you to work more effectively. You will not only to do the things you need to get done, but also schedule time to do the things you enjoy without stress.

What is an assessment, how does it help?

Everyone has strengths and weakness, both in terms of their cognitive abilities and their psychological processing of events, a psychological assessment allows us to take an inventory of those strengths and weaknesses. Assessments can look at your memory, your attention span, your ability to process, store and retrieve information, how you approach situations, what your emotional short-cuts are and how you relate to others as well as numerous other things. We start with a question like: “Do I have ADHD?” or “Why is it so hard for me to remember things” or “I work so hard, why can’t I learn as fast as everyone else?” Then a series of tests are chosen to help answer each question. The tests take all kinds of forms, some are multiple choice and/or true false types of tests, others are more like puzzles and some are more like tests that you would get in school. All of the various tests are then scored, interpreted, analyzed and compiled into a complete report which discusses all of the results and details your cognitive and psychological profile. This profile is then utilized to create an individualized plan to help you move forward, utilizing all of your assets to address your struggles.

If you are in school, planning to return to school or take a “high stakes” test such at the Medical Board Exams or the Bar Exam, comprehensive testing is necessary in order to receive accommodations such as extended time, a private room or a reader.

What does an ADHD assessment do?

ADHD symptoms are not always clear-cut. There are many other things that can present like ADHD such as anxiety, depression, learning disabilities and memory issues. Simple symptom inventories and quizzes can give you an idea if you symptoms match a standard pattern but they will not tell you if the symptoms are the result of ADHD or something else. A complete assessment looks at all aspects of cognitive and emotional functioning as well as a complete history in order to determine exactly what is causing your symptoms.
A comprehensive assessment does not stop at diagnosis. It also takes a full and complete inventory of all your strengths and weaknesses and then creates a plan to help you utilize those strengths to address your areas of difficulty. From there, we can create a roadmap to help optimize your success.

Why can’t I use my insurance?

It is understandable that after paying the huge fees that insurance charges, you would want to use it to pay for all of your medical treatment and while that is often a good option for physical issues it is more nuanced for mental issues. The pros of using insurance are obvious. However it is important to consider the cons before making your decision:

DIAGNOSIS: In order for an insurance company to pay for mental health treatment they you must have a mental health diagnosis; which is causing significant functional impairment. This rules out many people who have subclinical issues or who are looking for therapy for coping, relationship issue or coaching.

LOSS OF CONFIDENTIALITY: One of the biggest concerns with using insurance is the possibility of losing confidentiality. When insurance is billed they gather information including what your diagnosis is, what type of treatment you are receiving, if you have shown improvement and when your symptoms began. Additionally, insurance companies can audit your records and have full access to all of the details of your treatment including progress notes, which include what occurred during a therapy session. Insurance claims pass through an average of 14 people while being processed and each of these people has access to all of that information. Confidentiality is a cornerstone of the therapy process and this type of access, while easy to overlook, undermines that vital building block.

SPECIALIZATION: When a clinician accepts insurance they, by nature of their contract with the insurance company cannot specialize. They are required to take any client for whom they accept their insurance if they have an opening even if that client’s issues are outside of their area of expertise. This is similar to going to see your primary care physician to treat your heart disease. Sure, they could have some ideas of what is going on and give you some good directions for treatment but would they have all the best tools to diagnose and treat you?

LOSS OF CONTROL OF TREATMENT: When you use an in-network provider the insurance company gets to dictate how many sessions they will cover and therefore how your therapy progresses. This is usually determined ahead of time and is not based on need. Often the insurance company’s goal is to get you out of crisis and back to minimal functioning. Truly effective treatment which not only restores functioning to improves your quality of life is very rarely, if ever, covered.

PRE-EXISTING CONDITIONS: With the overturning of the ACA, health insurance companies can now deny coverage again to people with pre-existing conditions. This means that having a mental health diagnosis on your record can now make it difficult, if not impossible, to attain new medical coverage, particularly if you may ever need to purchase your own benefits.

WAIT TIME / THERAPIST SELECTION: Unfortunately because of all of the issues outlined above as well as the logistical hurdles that accepting insurance as an in-network provider creates, many therapists do not accept insurance. This creates a supply and demand issue, which then causes people to have limited choice in therapists and have to wait for an incredibly long time for a first appointment. Given how hard it can be to make that first step to get help and how important it is to find a good fit with a therapist, this is extremely unfair to clients and causes significant further distress during an already difficult time.

Because of all of these issues, I have chosen not to contract with insurance companies. Some clients chose to work with me as an out-of-network provider in which they pay me up front and then submit their invoices for reimbursement. This does not address the issues of diagnosis, confidentiality and pre-existing conditions but it does grant us both greater control of the treatment. Another solution is using a health savings account to pay for therapy or to retain your receipts as all visits to psychologists and psychiatrist are tax deductible when paying out of pocket.