What if I Can’t Afford Counseling?

Unfortunately, a sad truth about counseling is that it can be expensive.  In Boulder, CO, where I work, typical fees for a 50 minute session seem to range between about $90 and $150. If you don’t have health insurance that covers counseling, or don’t want to use it (for example, if you are a teen who doesn’t want to involve parents, or if you don’t want a of record of your counseling history), or if you’ve already used up the few sessions your insurance covers, then what do you do?

The first place you may think of for low-cost counseling is a community mental health center. If you have a serious mental health problem, and limited resources, it is definitely worth checking with your local mental health center to see if they can help.  Unfortunately, mental health centers are usually overtasked, and underfunded.  Therefore, it may take some time to receive services at a mental health center.  

But don’t assume that that is your only option.  People with less serious needs, and/or some resources, may find that it is also possible to find relatively low cost counseling from other providers.  One option is to look for counselors who accept sliding-scale fees. This means that the fees are adjusted depending on the client’s ability to pay.  Other counselors may offer lower fees for a limited number of sessions, for clients with temporary financial difficulties.  Some counselors who accept these lower fee arrangements may be less experienced, but still well trained and qualified to work with you.

One way to find counselors in your area who offer a sliding fee scale is to search the Psychology Today Find a Therapist web site.  You can search by zip code, or state and city.  Then check the profiles of the counselors you find who look good to you.  In each profile there is a Finances section that shows their typical fees, and whether they use a sliding scale.  If they do, then it might be worth calling them to see if they will accept what you can afford to pay.  If not, they may be able to refer you to someone who will.

If you are lucky, there may be counseling organizations in your area that help you find low-cost counseling.  For example, in Boulder there is a counseling cooperative, called Boulder Counseling Cooperative, to which you can pay a modest annual fee ($50 to $125) and then relatively low per-session fees ($20 to $35).  The fees you pay depend on your income, and the counselors are well qualified, licensed professionals. 

Have you found affordable counseling in other ways?  Write in and let us know how you found it.

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Peg Shippert is a psychotherapist in private practice in Boulder, Colorado.  She has a deep passion for working with survivors of sexual violence and other traumas.  She does offer a sliding fee scale.

The Body as a Resource for Resolving Trauma

I attended an inspiring workshop over the weekend, presented by Drs. Bessel van der Kolk and Pat Ogden, two huge names in the field of trauma treatment.  The topic of the workshop was the use of the body, and particularly physical rhythms, to help resolve trauma.  One of the big nuggets of wisdom that I took away from the training was that two interventions can be particularly helpful for resolving trauma: 1) activation of interoception, which is sensitivity to stimuli originating inside of the body, and 2) purposeful physical action directed toward the traumatic event. 

Women in yoga class, courtesy of National Institute on Aging

An idea fundamental to both of these interventions is that when we are faced with a trauma, our bodies naturally and unavoidably prepare to act.  But when we then are not able act, those physical impulses don’t just go away.  They remain in the body, and are reencountered over and over again, as the trauma survivor is reminded of the traumatic event. 

The first suggested intervention, activation of interoception, is important because so many trauma survivors lock away awareness of physical sensations, because touching in to those can be so scary and unpleasant.  And yet, those sensations also give us information about how to discharge the pent up tension from the traumatic event.  So, the first step is to safely develop skills and tolerance, sometimes extremely gradually, for being aware of what is going on in our bodies. 

Some of the ways that were mentioned during the workshop for developing this interoception include yoga (and I would think that Pilates might be even more useful here), contact improvisation, meditation, boxing, and dancing the tango.  The key is that it should be some physical activity in which it is necessary to make subtle connections between what happens in the mind and in the body. Sometimes trauma survivors need help creating a safe environment for these types of activities.  A good trauma therapist should be able to help survivors with this.

Once the capacity for interoception is developed, the next suggested intervention is intended to help discharge those “stuck” physical responses.  They key here is that you can’t discharge the physical tension from a traumatic event in a general way.  The discharge has to be connected to the original traumatic event. So, how do you do that?  Drs. Van der Kolk and Odgen showed several examples.  We saw one video in which the survivor of a traumatic assault was graduating from a Model Mugging class.  Her final exercise was a reenactment of her original assault, only in the reenactment she successfully defended herself from the perpetrator.  Other videos included exercises in which the survivors discovered and explored bodily impulses, such as making a fist or making a stop signal with the hand, often with added verbalizations (“stop right there” or “stay away from me”).  Having a chance to discharge these pent up physical tensions in a safe environment seemed to open the door to a deeper resolution of the trauma than was achieved for these survivors through years of talk therapy.

“Overcoming Trauma Through Yoga “ looks like an interesting book on this subject.  I have not yet read it, but it’s now on my short list.  It was written by David Emerson and Elizabeth Hopper, Ph.D., two practitioners at The Trauma Center in Brookline, MA, which was founded and directed by Dr. Bessel van der Kolk.

Have you noticed a correlation between working with your body, and working with your mind?  What types of physical activities have you found most helpful?

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Peg Shippert is a psychotherapist in private practice in Boulder, Colorado.  She has a deep passion for working with survivors of sexual violence and other traumas.

Some Great Guided Visualizations

Sometimes dwelling on big problems like sexual violence can get a person down.  So, this week I’d like to point out a resource that I find helpful when I need some rejuvenating and resourcing.  I initially found the guided visualizations provided by Belleruth Neparstek and others at Healing Journeys, Inc. years ago when I was facing a scary medical procedure.  Her soothing voice and gentle guidance helped me to feel supported in my journey, and confident in the outcome.  I am convinced that they significantly reduced my stress going into the procedure, and improved the speed of my recovery.

I was reminded of Belleruth’s work recently by a consultation group in which I participate.  The discussion there inspired me to revisit the Healing Journeys web site, where I found several gems that I now own, or have placed high on my wish list.  My favorite discovery is that Belleruth, a psychotherapist herself, has produced guided visualizations specifically for those suffering from post traumatic stress.  On the site, Belleruth claims that her “Healing Trauma” guided imagery is the best work she’s done, which I expect means that it is very fine work indeed.  

Belleruth recommends that most people start with guided imagery designed for general stress relief, sleep enhancement, and grief, which sounds like good advice to me.  I find it to be critical to develop good resources for tolerating and containing difficult material before starting to work directly with any trauma.  Fortunately, Healing Journeys provides several guided meditations to help with that.  I am most interested in those by Belleruth herself, and so I have added her “Relieve Stress”, “Healthful Sleep”, and “Ease Grief” MP3s to my wish list as well. 

I have no relationship at all to Belleruth Neparstek or Healing Journeys.  I have simply found guided imagery to be very helpful both personally and professionally.  And I have found Belleruth’s work to be of the highest quality.

What resources do you find useful for taking care of yourself, and building resources for facing life’s more difficult realities?

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Peg Shippert is a psychotherapist in private practice in Boulder, Colorado.  She has a deep passion for working with survivors of sexual violence and other traumas.