When things are not okay...

I've got help for you.

I’ve been profoundly NOT OKAY. I’m not sure I’d be functioning half as well as I do without the aid of a gifted therapist. Therapy has been a life-line for me over the past three years. I’m strong, but I’m stronger with a support system.

It’s Mental Health Awareness Month, my wonderful RDG Community,

I’m a big fan of therapy. But I do think there are tactics to maximize its effectiveness.

I reached out to a spectacular human, Karen Gutierrez, and therapist to help us navigate the system, misconceptions, her thoughts on finding the right fit, how to make a session great, coping during the search (omg those tips were especially gold for regulating stress during crisis), and her thoughts on the new AI therapy trend.

She had tons of resources and ideas too for folks who want therapy but need help with the cost.

But first, the budget bill passed the house by a slim margin of 514 to 515 votes- this bill will seriously impact and defund Medicaid and Medicare while providing tax breaks to the uber wealthy. Your advocacy could make the difference as the bill goes to the Senate.

Call or email your senators.

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Q&A With A Therapist!

1. What made you interested in pursuing therapy as a career?

I’ve been drawn towards helping others. Initially in undergrad I thought this meant being an elementary school teacher. I was on track to graduate within this career path, then decided two years in that it wasn’t for me. I knew I still wanted to help others, but was unsure in what capacity.

Then there were several heavy losses and situations within my family that helped clarify for me. I witnessed how my mom and other family members were dealing with these heavy events. I was drawn to how drastically different every one was managing it and became curious as to why. I changed my major to psychology, graduated, and pursued my masters in marriage and family therapy.

As a first-generation Mexican American, I find fulfillment in helping other first-generation clients create healthy boundaries with their families and help break the stigma of asking for support.

I’m listed on Headway. More information on my style and approach here.

2. Some people think getting a therapist sounds daunting. Can you talk about the path to finding a great therapist? Are there ways to make the process more fluid?

Feeling overwhelmed with finding a therapist is common and normal.

—Clarify what you’re looking for: Ask yourself what you need support in e.g. anxiety, depression, stress, life transitions, grief, trauma, etc. In-person or Telehealth services? Are you looking for a provider with specific identifiers e.g. cultural background, religion, gender, gender identity? What is your budget?

—Search therapist directories (some provided below).

—Most providers offer free 15-20 minute consultations. Reach out and schedule with a provider! This is an opportunity to hear about the provider’s approach and experience and to share a bit about what brings you into treatment. A consultation is also a great way to identify fit and connection between you and the therapist.

—Don’t overthink the email or call. “Hi, I’m looking for support with [topic], are you accepting new clients [in-person or telehealth]? Optional: I’m hoping to use insurance /would need a sliding scale / am paying privately.

—It is encouraged to shop around and speak to a few providers before finding one that feels like the right fit!

3. For the uninitiated, can you explain the difference between a social worker, psychologist, psychiatrist and a licensed counselor? How do we know what's best for us?

—Psychologists have a doctorate in Psychology. PsyD or PhD. Best for individuals seeking in-depth psychological assessments for neurocognitive disorders, ADHD, personality assessments, learning disabilities, among others.

—Psychiatrists are medical doctors, MDs, specializing in psychiatry, a speciality focused on treating mental health. Best for individuals seeking a medication prescription to manage mental health concerns. Meeting with a psychiatrist may also be indicated when therapy alone is unresponsive.

—Licensed Professional Clinical Counselors (LPCCs), Licensed Clinical Social Workers(LCSWs), and Licensed Marriage and Family Therapists (LMFTs) have masters degrees in counseling, social work, and marriage and family therapy respectively. The differences between these lies in the types of classes or training emphasized during their education. For example, LCSWs may have had an emphasis on larger societal factors such as discrimination and poverty. LMFTs in relationship dynamics. All can diagnose and focus on the treatment of mental health concerns via different modalities of care depending on training and specialty e.g. Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR).

4. Sometimes finding professional help takes a moment, and we're often looking while in crisis or experiencing acute trauma. When a patient is in crisis-mode, and trying to find a therapist, what can a person do to cope in the meantime?

—If you’re feeling unsafe or that you may be a danger to yourself or to others, have a safe, trusted person take you to the nearest emergency room or call 911.

—If you’re needing immediate support the following mental health crisis hotlines are available for emotional support:

—Call 988, the national mental health crisis hotline

—Text “HOME” to 741-741, text-based national mental health crisis hotline

—Reach out to supportive individuals and let them know what you’re going through.

—Use mental health based apps such as Calm, Headspace.

—Use Distress Tolerance coping skills (from Dialectical Behavioral Therapy):

• —TIPP Skill: Rapid, body-based techniques to help calm the nervous system and bring down emotional intensity quickly.

T: Change the temperature of your body. Hold your face in cold water or place an ice pack on your cheeks (near your eyes). This stimulates the dive reflex and slows your heart rate.

I: Burst of intense exercise e.g. jumping jacks, planking, wall sits, running in place. This helps release adrenaline and calm the body.

P: Paced breathing. Inhale slowly (about 4–6 seconds), exhale more slowly (6–8 seconds). This activates the parasympathetic nervous system.

P: Progressive Muscle Relaxation I.e. Tense and relax different muscle groups to reduce tension and regain control of your body.

• —5 Senses Grounding

Sight: Look at calming images, a favorite photo, nature.

Sound: Listen to music, white noise, a calming playlist.

Smell: Light a candle, use essential oils, smell something familiar.

Taste: Eat something comforting but grounding (tea, mints, sour candy, fruit).

Touch: Wrap in a blanket, take a warm shower, hold a weighted object.

5. What would you say to someone who is curious but feels skeptical about the effectiveness of therapy?

Feeling skeptical is normal. You’re meeting with someone you’ve never met and are sharing the most vulnerable parts of yourself. Some things you may be saying out loud for the first time ever. The fact that you’re skeptical is a big step in and of itself because it means you’re approaching it thoughtfully. You get to decide what and how much you share with your provider. An effective provider never forces you to share.

There’s decades of research showing the benefits of therapy. It is a safe, non-judgmental way of processing your emotions and thoughts while giving you the tools and coping skills to manage stressors. Mental health is just as important as physical health and each one impacts the other.

6. Sometimes we'll get a list from our insurance company and none of the providers take the insurance? Can you explain why that seems common?

Our system is inundated. The administrative burden of being paneled with an insurance company (I.e. take insurance) takes a long time. Similarly, requesting to no longer be paneled with a company also takes a long time.

Even if a therapist recently joined or left a plan, there’s often a lag between when that change happens and when it’s reflected in the directory. So you might be seeing old or inaccurate information. Additionally, providers may not be accepting new clients by the time you get a hold of their information.

7. We all know not every insurance is created equal and money can be tight? What options exist for more affordable therapy?

OpenPathCollective.org

This is an out of pocket therapist directory that ranges from $30-70. The more cost effective sessions are with providers that are in the process of receiving their hours for licensure or are currently student interns. These providers are called “Associate MFT” or "Associate CSW.” The higher range cost is for choosing to meet with a licensed clinician.

I believe there’s a pre-conceived notion that Associates are not as effective as providers that are licensed clinicians. I was an associate once and I didn’t know things then that I know now.

But that’s also true of being a licensed clinician. We don’t have all the answers and are not trained in every area. An effective clinician, licensed or not, is one that takes the time to get trained, learn, ask questions, and consult with other professionals.

headway.co

This is a therapist directory for active providers that take various insurances. As you pointed out, insurance-provided lists don’t tend to be up to date. Headway is trying to bridge the gap between access for services for clients and the administrative burden for providers dealing with insurance. According to their website, 70% of therapists don’t take insurance because of the administrative burden. It can also take insurance a significant amount of time to reimburse clinicians for sessions.

therapyden.com

This is a therapist directory for active providers that take various insurances and/or offer sliding scale rates as low as $40. Simply toggle the filter by state, specialty, insurance and rates.

Requesting Superbills from providers

For out-of-network providers, clients can request a “Superbill,” which is a detailed receipt for services rendered by a therapist, to receive reimbursement from their insurance company.

However, this route requires clients to pay upfront costs, verify with their insurance that the diagnosis/ses are covered and that their insurance is able to reimburse. Similar to why most providers don’t take insurance, the administrative burden and delay to get reimbursed might be a deterrent for clients.

Sliding-Scale Fees

Some private practice therapists may have slots for clients seeking a sliding-scale rate, which is a reduced price from the provider’s full fee. Therapists are used to having these conversations, and asking about cost will not affect your care or the therapist's willingness to help.

Consider asking the following:

"Do you offer a sliding scale or any reduced fee options?”

"I’m interested in working with you, but I have a limited budget. Is there any flexibility in your fee structure?”

County Department of Mental Health (DMH) Clinics

Each county in CA has a Department of Mental Health (DMH) that operates non-profit community clinics. Eligibility factors may be minimal and include income level and insurance status (uninsured, underinsured, or medi-cal recipients), but each clinic has it’s own intake process so it is best to reach out and ask.

Consider asking: ““I’m looking for affordable therapy and I’m not sure what I qualify for—can you help me understand your intake process?”

Ways to find a provider include the following:

—Visiting the Los Angeles County DMH site and searching for a clinic in your area: https://dmh.lacounty.gov/pd/

—Calling Los Angeles County DMH Access Healthline @ (800) 854-7771; Option 1, then Option 2 for “Information and Referrals”

—Calling 2-1-1 or visiting https://211ca.org/ This is a free and confidential service that links callers with social services.

I worked at a Los Angeles County DMH clinic so I’m most familiar with their process. However, the process and options are similar for other counties all over the states. You can google

“[County name] Department of Mental Health."

8. For best results, especially when starting therapy, what can a patient do to prepare for a session?

—Complete all intake paperwork ahead of time! Intake paperwork can be extensive, but it’s for a reason. We need context! This can also help you reflect on past and recent experiences that might be contributing to your current symptoms. Intake sessions are typically 50 mins and it’s impossible to get through every bit of history in general, but this is especially true if the intake is filled out with minimal information. Help us help you.

—Clarify your goals: What brings you to seek therapy at this time? What are you hoping to gain from services? Having a general idea is okay!

—Be patient with yourself. Therapy is a process that takes time, effort, and consistency.

9. Not every therapist is a good fit. Can you talk about signs that the therapist is effective versus ineffective?

The overall predictor about successful therapy is having a good rapport with your provider. Think of it this way—if you don’t feel comfortable talking to your provider, how likely are you to be honest and open about the most vulnerable parts of yourself?

Signs that your provider is effective:

—You feel heard, respected, understood and accepted even when discussing vulnerable topics.

—There’s a clear treatment plan and goals. Every provider approaches this in a different way, but overall there is a sense of structure and path towards addressing your concerns.

—Boundaries, boundaries, boundaries! Appropriate self-disclosure on behalf of the therapist. They’re engaged but not oversharing. This is your session not theirs.

—Scope of competence/practice: The provider stays within their scope of practice—they don’t give you advice on things outside of therapy e.g. financial, legal, medical advice, etc! They also stay within their scope of training. They’re honest about what they feel less or more highly trained in.

—You experience growth and insight. However, therapy isn’t a magic wand. Be patient with yourself. Therapy is a process, but if you start feeling that sessions don’t really go anywhere, that may be a sign that something needs to change.

—The provider adjusts based on your feedback and doesn’t take it personally. Therapy is a collaborative effort. What works for you? What doesn’t? What needs to change for you to feel sessions are supportive?

10. Often great therapy can bring up hard feelings - what do you recommend after a session to prepare for the rest of the day?

If possible, give yourself a buffer between session and the next thing you dive into. Even 10 minutes can help. Take a mindful walk, sit in silence, listen to music, engage in a mindfulness practice (deep breathing, meditation, yoga), journal what you’re feeling and/or what you want to address next session, eat or drink something, be kind to yourself.

If you’re unable to take 10 minutes after session, acknowledge things may feel a bit heavier and be gentle with yourself. Remind yourself this is part of the process and it’s okay to feel uncomfortable.

11. Thoughts on the new trend of AI Therapy?

It doesn’t surprise me but it does make me nervous! I like to believe that it will be difficult for AI to replicate genuine emotion, but I’m unsure given how fast AI is progressing.

However, I think AI therapy may end up being more appropriate for milder symptoms

12. Anything else you'd like to share or promote with people who read my Substack?Any other resources you find helpful?

You’re not alone. Take care of your mental health. It matters. You matter.

Latinos living with Rare Diseases. Focuses on empowering Latino families affected by rare diseases through education, support, and advocacy. They offer bilingual resources and peer support groups: https://somosrare.org/

Your Substack is doing wonderful things. Thank you for sharing your journey. It’s an honor to know you and call you a friend, Taylor.

Meet Karen Gutierrez

I'm a first-generation Mexican American and am bilingual in Spanish and English. I come from a family of immigrants and am the first in my family to receive a Masters degree. As such, I make a conscious effort to take into account how culture and upbringing impact my clients' experiences.

In my over ten years as a provider, I’ve worked in school settings, community mental health and for a large healthcare system working with clients from childhood into older age, and ranging from mild to severe depression and anxiety, stress, trauma, grief and loss, and adjustment difficulties.

A bit about my approach to therapy:

I work from a Cognitive Behavioral Therapy lens--an evidence based practice to show how your thoughts impact your feelings and behaviors. I also incorporate techniques from other evidence based modalities including Positive Psychology, which stresses mindfulness, gratitude and resilience, and Dialectical Behavioral Therapy, which includes learning skills in mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation.

What you can expect from our first session:

I believe that the way we approach our challenges matters, which includes having compassion for ourselves.

In sessions I hope to provide a safe, non-judgmental and collaborative space, stemming from a place of compassion where clients feel supported and heard.

Disclaimer:

***Karen is answering this as an LMFT in CA***

Karen personally uses Headway for her private practice, but is not receiving any compensation for sharing about their services.

PS: Karen is not my personal therapist.

Hi Readers. Do you find therapy helpful? What tactics have helped you navigate the system or make the most of a session?

Have you ever had a question for me? Maybe a burning curiosity or advice on a situation? Click on Ask Rare Disease Girl, ask an anonymous question, and I’ll respond to in a post.

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DID YOU MISS IT?

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If you’re new here and wondering, “what happened to this lady?” read:

I started writing this when I was on dialysis. It’s intended to be both memoir and a practical tool to help folks who might be going through something similar or those caregivers and family supporting someone with a challenging diagnosis. NOTE: This is not intended to replace actual medical guidance. Please consult your doctors on your individual challenges and situations. Please talk to your clinicians before adjusting any of your care protocols. Also names have been changed for most of my medical staff.

THANK YOU, NEW PAID SUBSCRIBERS!

Thank you to Katie McUpton, Dienna D’Olimpio Harada, CC Couchois, Roy Lenn, and Dr. Richard Burwick for your founding level donation.