Surviving Toddler Tantrums

Your child asks for water. You give your child some water. And suddenly the screaming starts…What is going on? The water could have the wrong temperature, could be in the wrong cup, your child may not like the way you handed them the water – who knows. The one thing that is clear is that your child is about to have a tantrum. Read on to learn what tantrums are, why they happen, how to deal with them, and better yet, how to prevent them. 

Tantrums are your child’s form of protest. They come in all shapes and sizes and may involve screaming, stiffening limbs, an arched back, kicking, falling down, flailing about, or running away. In some cases, children hold their breath, vomit, break things, or hurt themselves or other people as part of a tantrum. 

Tantrums are normal, common, and expected. Between the ages of two and four, over 90% of children will have tantrums. Tantrum throwing tends to peak during this age range because children are still at the early stages of social, emotional, and language development. They can’t always communicate their needs and feelings which often leads to frustration.  And they’re learning that how they behave can influence others. So tantrums end up becoming one of the ways children learn to express their feelings and change what’s going on around them. 

Before moving into strategies on how to help prevent and ease tantrums, it is important to clarify what tantrums do not mean. Tantrums do not mean you are failing your child or are a bad parent. Tantrums are not a sign that you have a bad kid or that your child is trying to manipulate you. It is common for parents to take tantrums personally and react accordingly, but really what your child is doing is completely developmentally appropriate. 

Ways to make tantrums less likely to happen: 

• Identify tantrum triggers like tiredness, hunger, fears, or overstimulation. You may be able to plan for these situations and avoid the triggers

• Help your child understand their feelings so they do not feel as big. This can start at birth by using words to label feelings like “happy”, ”sad”, “angry”

• Have your child tune in to the feelings they have when they move through a stressful situation without a tantrum. For example “Mommy said we had to leave the park and you left without getting upset. How did that feel? Did you feel calm?”

• Model positive coping strategies for handling stressful situations. “I am getting worried we will be late because of this traffic, I am going to take a few deep breaths” 

• Offer choices in decision making to encourage independence “Would you prefer to wear the orange shirt or blue shirt today?”

Ways to help you and your child through the tantrum: 

• Use a mantra - repeating a mantra can help you keep your cool, which will allow you to have more emotional resources to support your child. Some mantras include 

  • “It’s not personal - it is normal and developmentally appropriate”

  • “They are not giving me a hard time - they are having a hard time”

  • “Stop and take a breath”

• Say less - being rational adults, we like to talk ourselves out of problems, but when your child is in the throes of a tantrum sometimes saying less is more. Their feelings can be so big that any explanation is best saved for when the tantrum is over

• Offer empathy and acknowledgement  - Even though your child may be losing their mind over something that feels silly to you, like not being able to wear the ketchup-stained shirt from yesterday, speaking to your child with empathy will help them feel seen and understood 

• Stay calm but do not give in - your child will mimic what you do. If you take deep breaths and regulate your emotions, your child will have an easier time doing the same. You can acknowledge your child’s frustrations in a calm way and not give in, which will only reinforce the tantrums. An example of this type of statement would be “I see that you are very angry and frustrated that we have to leave the park, but we cannot stay here any longer” 

When you have made it through a tantrum, it is important to remind your child how loved they are even when their feelings are so big. A hug will remind your child that they are secure with you and you are not deterred by their tantrums. When the tantrum is over, it is important to debrief with your child and narrate the course of the tantrum, from the trigger to the behavior to the calm down. This will help your child understand that their feelings are in reaction to something. 

Tantrums can be very triggering depending on our own childhoods and the ways we learned to deal with negative emotions. If you are finding it difficult to follow these tips or remain calm in the face of your child’s distress, it may be important to better understand and process your emotional responses to your child’s dysregulation. 

If you’d like help navigating parenting, click here for a consultation with one of our parenting specialists.

Simple Grounding Techniques

While it is important to understand and feel our emotions, not every occasion is appropriate or useful for doing so. You can use these simple grounding techniques to help you detach from emotional pain that isn’t effective for you to feel in the moment. Grounding techniques work by shifting your attention and focus to something other than the difficult emotions or thoughts you are experiencing. 

Color Breathing

Mentally picture a color that represents how you want to feel (i.e. Blue for relaxation, orange for joy, green for healing) and a color that represents what you want to let go of in life (red, for instance). 

Get in a comfortable position and allow yourself to relax. Now breathe in the color of your choice for 2-3 seconds, imagining yourself bathed in the color. Now breathe out the color that represents what you want to let go of for 4-6 seconds, imagining it fully leaving your body. Note that your exhale should be twice as long as your inhale for best results. 

5-4-3-2-1 Grounding Technique 

Use all 5 senses to help you refocus and bring you back to the present moment

First, look around you and name in your head 5 things you can see (you can look within the room and out of the window)

Then touch 4 things you can feel (the silkiness of your skin, the material on your chair, the texture of your hair) 

Then listen for 3 things you can hear (traffic noise, birds outside...you would be surprised how many things you hear that you normally tune out when you’re mindfully listening!)

Then notice 2 things you can smell (hopefully nothing awful!)

And finally, 1 thing you can taste (the taste of your mouth, a sip of a drink)

Positive Self-Talk 

The way we talk to ourselves matters and affects our emotions. Notice how your mood shifts when you replace catastrophizing statements with more realistic and positive self-talk. Sometimes it can be useful to consider how you might speak to a friend or a child. It may help you realize how harsh you’re being to yourself. 

“There will be difficult moments as I take the test, I expect them and can handle them now” vs. “I am definitely going to fail”

“I feel good about myself and most of my abilities” vs. “I am a failure because I am struggling with one task”

“I may have done poorly on this test before, but now I have the skills to pass this test” vs. “I failed once and will likely fail again”

Remember: Although grounding techniques won’t solve the original problem causing your distressing emotions, they provide a temporary way to gain control over your feelings and prevent yourself from making things worse.

If you’d like to seek out more grounding techniques at Therapist of New York, contact us here.

More Than Just the Baby Blues: Postpartum Depression

When a baby is born, many assume that the birthing parent will be nothing less than overjoyed. However, it is more typical for birthing parents to experience a range of complex emotions after bringing a baby into the world. When these emotions become predominantly negative and longstanding, leaving parents feeling like they don’t know what to do, where to turn, or whom to ask for help, they may be experiencing Postpartum Depression (PPD).

There has been a steady increase in attention on PPD over the past two decades. There are two reasons for this. First, it was officially recognized as a distinct mental illness in the late 1990s which led to an increase in the science and literature on the subject. Second, celebrities have begun to speak out about their experiences with PPD, which may have eliminated some of the shame around the subject and helped others understand their own experience.  But what actually is Postpartum Depression? 

What Does PPD Look Like?

Many are familiar with the “baby blues”, or a two-week period after delivery where a birthing parent’s mood may be lower than normal due to a drop in hormones. This may look like intense crying, an increase in anger or anxiety, and feelings of sadness. The key is that whatever the symptoms are, they only last for a short time. Postpartum depression on the other hand tends to be more severe and long-lasting. Some of the symptoms of postpartum depression include: 

• Feelings of anger or irritability

• Lack of interest in the baby

• Crying and sadness

• Feelings of guilt, shame, or hopelessness

• Loss of interest, joy, or pleasure in things that you used to find enjoyable

• Possible thoughts of harming the baby or yourself

If you identify with any of these symptoms, the first thing to realize is that you are not alone….1 in 7 women and 1 in 10 men experience postpartum depression. These numbers may even be an underestimation, as experts agree that PPD is often under diagnosed because those who endure it may be too ashamed to seek help.  There is help though! 

Ways to get Help 

1. Build A Support Network

   1. New parenthood can be a very isolating time, so reach out! If you do not have close friends or family nearby, consider trying baby and toddler classes, join a local parent Facebook group, or download apps like Peanut that can connect you with other parents.

1. Take Care of Yourself

   1. So much of new parenthood is an identity shift, so finding ways to connect back to the “you before parenthood'' is critical in helping to cope with the postpartum period. This may look like, getting out in the sunshine, pampering yourself, exercising (when medically appropriate), or watching a favorite TV show. Whatever “it” is, finding space to have “you” time is incredibly important.

1. Psychotherapy and Medication

   1. Therapists can help an individual better understand their depression and also provide tools and skills that can help a person better cope with the postpartum period. Here at Therapists of New York there are clinicians specifically trained to work with individuals who are experiencing postpartum depression.

   2. If the depression is very severe a doctor may suggest antidepressants in addition to therapy to help combat the symptoms.

Resources and Ways to Learn More & Find Help

1. Postpartum Support International - https://www.postpartum.net/

2. Postpartum Progress - https://postpartumprogress.com/

If you’d like to seek out help for postpartum depression at Therapist of New York, contact us here. You can also read more on how we work here.

Before The Aisle: Building a Modern Marriage

As the “mental health generation” prepares to walk down the aisle, psychologically-minded couples are considering premarital counseling to start their unions on the right foot. Despite this growing interest, many couples wonder: what is premarital counseling, anyway? 

While some religious leaders require premarital counseling in order to marry couples, more and more couples are seeking secular marriage preparation to either supplement or replace this traditional practice. Regardless of religious or secular affiliation, premarital counseling is a strengths-based, wellness-focused approach to relationship health. At Therapists of New York, we see premarital counseling as an opportunity to capitalize on the excitement and hopefulness for the future that comes with the desire for a greater commitment. That is why we offer Before the Leap, a fun and interactive workshop for couples entering the next phase of their relationship that teaches the skills needed for happy, lasting partnerships.

Premarital counseling is quite different from couples therapy. When couples come to couples therapy, they have often been in crisis for far too long - studies show that couples spend, on average, six years in distress before seeking therapy! Couples therapy often must address long-standing, entrenched conflict patterns and communication issues, as well as years’ worth of resentment related to these ongoing cycles. Premarital counseling is an opportunity to foster open conversation and healthy communication habits at the outset of this next chapter. 

Research supports the efficacy of premarital counseling; studies show that couples who have engaged in premarital counseling are 30% more satisfied in their relationships, report lower rates of conflict, and are less likely to get divorced. Premarital counselors guide couples through difficult conversations, and the sessions provide an opportunity for the development of a shared language to express your needs, wants and emotions to one another in the short-term and beyond. The sessions are an opportunity to reflect on your goals for your future together before walking down the aisle- many couples even end up incorporating some of what they’ve learned in premarital counseling into their vows!  While couples typically seek out premarital counseling once they are engaged, other couples come in anticipation of getting engaged, before moving in together, or before getting a pet together. Regardless of the type of commitment you are making, the same principles apply.

Premarital counseling can be conducted with the couple and the counselor, or in a group format. It is typically short-term and more structured than couples therapy. Topics explored in these sessions may include:

• The meaning of marriage (or commitment) for each of you

• Communication skills

• Conflict resolution skills

• Financial goals and priorities

• Family of origin dynamics

• Raising children

• Sexuality

• Religion

• Division of labor

• Building rituals

• Shared/individual goals and dreams

When planning a wedding, there are innumerable checklists, to-do lists, and traditions to keep track of. It can be easy to get swept up in the many decisions to make for that “big day”. In between the venue visits and cake tastings, remind yourselves what your wedding is ultimately about: the decision the two of you have already made, to make a powerful commitment to one another.  Premarital counseling is one way to honor and protect that commitment. 

If you’d like to seek out premarital counseling at Therapist of New York, contact us here.

Dating: Not for the Faint of Heart

Dating, especially in New York City, is not for the faint of heart. This is one of the most discussed topics for our single clients. We caught up with Dr. Nadia Nieves for her advice on how to deal with some common dating concerns we hear from our clients:

“Dating is scary. I'd like to avoid it all together but I know it's something I have to do to find a partner."

• Many of us find the world of dating to be not only scary but chaotic, uncertain, and unfortunately, necessary. If you are struggling with this fear, first know that you are certainly not alone. Putting yourself out there is a risk; there is a risk that you could be rejected AND (sometimes even scarier) a risk that you may make an important connection.

• Secondly, consider what aspects of dating are particularly fear-inducing for you. Is it the first date jitters? Is it the fear of being ghosted? Is it not knowing what it feels like to really click with someone? Or is it something bigger than all of that? Being curious and clarifying what specifically feels scary or threatening to you can help you confront those fears. It can also help you identify ways to adapt and make yourself more comfortable in this process.

• Thirdly, have you thought about how you want to find a partner? Online dating seems to be our go-to these days. However, it could be worth it to think about whether or not your preference is to meet someone in a specific environment. Do you feel more like yourself at Comic-Con or a Garlic Festival than you do at a bar or online?

• Lastly, consider the possibility that most fishes in the sea can feel just as scared as you.

"I'm starting to like someone but I don't know how they feel about me. I don't like initiating conversations like this. What do I do?"

• You've connected with someone and now you want to know where it's going. The issue is that you want to know where the other person's head is at without actually having to be the one ask. Let's break down this very common worry.

  • What are you expecting? In other words, what is your gut telling you about how this person will respond if you bring it up?

  • What does it mean to you to be the first to bring something up? We often assume that these conversations just happen and should be effortless. However, that does not accurately represent reality. Since we are not mind readers, we typically have to ask if we want to know what someone's thoughts are.

"I'm sick of being ghosted. It makes me want to give up."

• Ghosting totally sucks. You think you've connected with someone and then all of a sudden the person disappears off the face of the earth. It's hurtful to go from receiving attention and connection from someone to getting nothing at all from them and being left on read. When someone ghosts you, you are being rejected, but it's the type of rejection that feels unclear, which makes it harder to accept and deal with. At some point, we start to realize that the likelihood of you encountering this again is very high because the ones doing the ghosting are avoiders, and there are lots of them. Whether or not these people are avoiding conflict or emotional intimacy, you are still left with a not so great feeling in the end that can be pretty demotivating. If you can't get that person to reappear, it could be worth it to experiment with calling ghosting out when it happens.

If you feel like you need more help in navigating dating, contact us here and we can set you up with one of our therapists.

Anxious about the Election? You’re not Alone.

Whatever the outcome of this presidential election is, many Americans feel like they will come out of it with both a newly elected president, and a new anxiety disorder. So many of our clients here at Therapists of New York are struggling to manage the intense emotions arising from what feels to many like a very high-stakes election. This sense of panic, dread and worry many are experiencing is a bi-partisan experience. NPR news reports that the majority of Democrats, Republicans and independents are all reporting high levels of stress related to the upcoming election.

Why am I so anxious? A contentious national election (during a pandemic, no less) is the perfect storm to drain our psychological resources. We have been living under the shadow of this election, unable to make it come faster, unsure about the outcome, and overwhelmed by the potential scale of the impact on the well-being of ourselves and our loved ones. A major element contributing to this anxiety is the sense of helplessness many are reporting. While you can of course (and should as long as resources allow!) participate in the democratic process, generally you won’t see the effects or impact of these actions until after the election. Fletcher Wortmann, author of Triggered: A Memoir of Obsessive-Compulsive Disorder, notes that it is only natural that our minds will feel restless and unsettled with nothing to expend that nervous energy on.

Ways to Cope

1. Get in touch with why you’re anxious: Okay, hear me out. I understand that when I ask WHY you’re anxious about the election, you may want to give me a death stare and just vaguely gesture around you. Of course you’re anxious, I get it!  But there is a lot of value in getting in touch with what your specific concerns and worries are. How do you fear the results might impact you or your loved ones? How will the results affect day to day life? Once you figure out what your specific concerns are, you can brainstorm ways to cope. This can help make the anxiety feel less diffuse and overwhelming.

2. Step up stress-reducing habits: Acknowledge this is a stressful time and set yourself up for success by treating your mind and body well. These are simple steps like getting enough sleep, eating well, maintaining social connections, and engaging in pleasurable activities.

3. Find the balance between involvement and taking care of yourself: Caring about and being emotionally invested in politics is not a bad thing. However, it is important that you maintain perspective and recognize the limits of your own time and resources. It is easy to fall into a hole of “I should be doing more.” There are many resources about ways you can feel like more of a participant in the democratic process, potentially easing some of that helpless feeling. However, be honest with yourself about what you feel like you’re able to do. Does going door to door to campaign increase your anxiety? Try phone banking via text for your candidate. Perhaps texting feels too draining, try making a plan to vote. At the end of the day, you’re the only one who can decide what the right balance of involvement and taking care of your mental health looks like.

4. Control media consumption: Scrolling through our phones and staying on top of the news cycle can become addicting. It is important to stay plugged into what is going on, but you probably don’t need to check the news every hour of the day. Do a check-in with yourself and be honest about whether your media consumption is helping to ease or adding to your anxiety. My personal strategy has been to limit my news intake to two periods at the beginning and end of the day (but not right before bed). This allows me to feel informed without feeling overwhelmed.

5. Prepare for delayed results: Due to the nature of the current election, it is highly likely that we won’t have a clear answer on election day. Start planning now for how you might want to spend that time. Consider what activities can help you feel less stressed and more fulfilled, and consider how you want to consume news during that time. Having a plan can help us feel less overwhelmed because although you can’t reduce uncertainty about the results, you can reduce uncertainty about how you will deal with it.

The most important takeaway here is that experiencing anxiety right now makes sense and is a natural product of the circumstances. Spend less time judging yourself for being anxious, and more time making an honest assessment of your own strengths and needs surrounding the election. 

If you feel like you need more support, contact us here and we can set you up with one of our therapists. Therapy can help you tackle some of these questions and better understand your anxiety. 

Sources:

Election Stress Is High. Here's How To Tamp Down The Anxiety : Shots - Health News

Suffering From Election Anxiety?

'Election stress disorder': How to cope with the anxiety as political tensions intensify

Reclaiming the Weekend: Setting Work Boundaries in the COVID-19 Era

It isn’t news to anybody that the COVID-19 pandemic has completely upended the ways that many of us are doing our jobs, with millions of people working from home for the first time ever. Before the pandemic, even the most dedicated workaholic had one key way to enforce the boundary between their work and home life: By leaving the office. Without a commute and physical separation from the office, many have felt the boundary between work and home dissolve, finding themselves overstressed, hunched over their computer at odd hours, and answering slacks and emails into the dead of night. 

As the pandemic drags on and businesses continue asking for more and more from their employees, this foggy blur of work, life, and video-chat has led many people to experience burnout and intense work stress. If you find yourself asking whether you live at work, or work from home, it can be helpful to create clearer boundaries between your home and work life. It is important to note that setting work/life boundaries does not mean you want to do less work. Appropriate boundaries can alleviate your stress while actually increasing your productivity and ability to engage in work by making sure you are getting the time you need to recharge and approach your job with renewed dedication and energy. This is something that was likely a lot easier and more natural feeling to you before you quite literally lived at your office. 

The process of creating a firmer distinction between work and home activities during this difficult time begins with you. The following strategies can help you to establish structures and routines for yourself without necessarily involving others: 

1. Get Dressed: Clothing is an important marker of how you are spending your time and can help shift your mindset into whatever activity you are dressed for. You don’t need to wear a full three-piece suit or put on heels as you might if you were going into the office, but it can be a powerful gesture to get dressed at the start of your workday. Similarly, change your clothes in the evening to indicate to yourself (and perhaps your family) that you are now done with work. This can be as simple as changing from your work sweatpants into your home sweatpants! 

2. Designate a workspace: Our minds begin to associate physical spaces with the activities we habitually complete in them.  Try to avoid the temptation to work from bed, which can negatively affect your sleep and sex-life. While a designated office is ideal, a reality is that many people, New Yorkers in particular, do not have the option to designate an entire room for work. In this case, get creative: Set up a corner of your kitchen table for your workspace, use a room divider to hide your bed from view, or get a folding desk that you take down when you’re done with work. 

3. Set up a schedule: Without knowing when your work hours actually are, you can’t know if you’re working outside of them. Maybe you enjoy having a more open schedule now that you are working from home. Some people have found a freedom in being able to begin work later or take a break in the middle of the day. Feel free to embrace these aspects of working from home but be clear with yourself about what your work hours are and be consistent and stick to them, even if they are outside of the “typical workday.” 

Now it is time to consider setting boundaries with the other people involved in your work life. This may include your boss, your coworkers, your employees, and even your family (if they are home with you during working hours). Often people struggle with setting boundaries at work out of a desire to be responsive to the needs and expectations of their employers and coworkers. While this behavior is coming from the desire to be a “good employee,” it often comes at the expense of your own needs, leaving you taxed and ultimately unable to perform at the level you want to. The graphic below demonstrates how accommodating every request and working long hours outside of your job expectations may become a cycle you feel trapped in over time: 

Breaking out of this cycle allows you to reclaim your time and your control over the quality of your work and productivity. Here are a few ways to decide what you would like to change and begin setting stronger boundaries with others: 

1. Decide what you need to work best: Spend some time reflecting on what you need to do the best job you can. This involves asking yourself questions such as, What times of day do I work best? What do I need from others to do my job more efficiently? What has changed in my job since the pandemic began that I am having a hard time adjusting to? What has changed in me since the pandemic began that I am having a hard time integrating into my work life? 

   • Concrete steps some of my clients have taken to create better work/life boundaries include speaking to their boss about changing their hours, putting a do not disturb sign on their home office, pausing their inbox at the end of the day, and logging out of the team Slack at night. 

2. Communicate your schedule: Whether you are a person who has embraced the flexibility of a work from home schedule, or are sticking to the hours you had in the office (or at least trying to), it is important to communicate to your team when they should expect you to be available. Now that coworkers can’t walk by your desk and see if you’re there, it is important to explicitly communicate when it is okay for them to be in touch. This applies to your family too. If disruptions from your spouse or children make it difficult to remain in your workflow, make it clear what times are and are not okay for them to interrupt. 

   • Whatever schedule you choose, make sure you stick to it. This maintains clarity for yourself AND your team. If you say you need an hour for lunch don’t make an exception and email your colleague during that hour. Take your time off just as seriously as the time you are working. 

3. Once you set boundaries, ENFORCE them. After communicating these new guidelines, if somebody violates your boundary, reinforce it the moment it occurs. This can be done in a compassionate way that fits your personality. For instance, if you receive a work-related text message at 9PM after expressing that you’d prefer not to be contacted outside of working hours, some people may feel more comfortable waiting to reply until the morning, while others may prefer to reply in the moment saying something like, “Thanks for letting me know about this. I will respond tomorrow.” Both options send the message that you are protecting your time and are not always available to work. 

4. Frame the communication about your boundary setting in a way that highlights the good for the entire team: It is a lot easier for your boss and colleagues to hear “no” if they understand you are saying it to improve the work experience for everybody. It is helpful to think of boundaries in terms of “if/then.” For example, “if you can wait until the morning for me to answer this email, then I will be able to respond in a more thorough and helpful way.” By protecting your time and energy, you are ensuring that you will be able to be there for your team when they truly need you.  

At the end of the day, remember that we are living through an unprecedented crisis: Establishing boundaries between work and home is always an important part of living a balanced life. However, as the pandemic continues and working from home becomes more normalized, it is important to check in and remind ourselves that our bodies and minds are taxed from living in such a stressful and unusual time. Even if we aren’t always consciously thinking about COVID-19, we simply have less resources than usual, and taking time to decompress is especially important. Remind yourself that you are a better employee if you can take the time you need to recharge instead of feeling drained and resentful of the demands being placed on you by work. 

Healthy Assertiveness in a Global Pandemic

Healthy Assertiveness in a Global Pandemic

Managing boundaries is challenging in the best of circumstances, but in a pandemic the stakes are higher than ever. One the one hand, we are hungry for contact as we feel isolated and afraid. On the other hand, interacting with others holds real risk to physical safety and health. Right now, the human need for relationships is in direct conflict with the need for safety. Some prioritize the need for connection but later report ‘post-hangout anxiety’: fear lingers after social events as they reflect on things they did that they did not feel completely comfortable with, berating themselves for not refusing the hug from a grandparent, the handshake from a tennis coach, or the invitation to watch a movie with a friend. Others are refusing to see others altogether, prioritizing safety over connection, which may result in feelings of isolation, hopelessness, or low motivation. In order to find a middle ground between these two basic human needs, healthy assertiveness is helpful in preserving your personal comfort zone by balancing these needs.

Assertiveness is the ability to stand up for your own needs while also respecting the rights and integrity of the other person. Though it sounds straightforward, assertiveness can be incredibly difficult. Some people hesitate to say “no” for fear of hurting the other person’s feelings, damaging the relationship, or seeming mean. If this resonates with you, you may fall into the more passive style. On the other hand, some people believe that their ‘no’ won’t be heard or respected in its own right, and so the rights and choices of others must be put second. These people are often called pushy or controlling by friends and family. If this resonates with you, you may fall into the more aggressive style. Assertiveness is the middle ground between these two styles of relating. Assertive people hold both the rights of the self and other to be equally true. In order to practice assertiveness, you must feel able to ask for what you want, while also allowing others to do the same. Difficulty with assertiveness has existed long before COVID-19, so while the tools below are framed in relation to pandemic safety, they are relevant and applicable to all interpersonal situations:

Tools For Healthy Assertiveness:

Take Your Time: The prefrontal cortex of the brain, which handles decision making and risk evaluation, can be harder to access when we are feeling afraid or unsafe. During a pandemic, being around others can trigger a fear response. It is therefore important to consider your boundaries ahead of time in a safe, comfortable space. If someone invites you to an event, let them know you are considering it and will let them know by a specific, reasonable time. Then, find a comfortable space where you feel relaxed to really consider the situation at hand. For example, imagine that your Aunt Jean has invited you to visit her. Before responding, reflect on what you need to feel safe, thinking through each step mindfully. What would make you feel most comfortable in terms of location, distance, masks, eating, traveling? Give yourself permission to identify whatever makes you feel safest. Refer to these activity-specific CDC guidelines (https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/going-out.html) if you’re unsure of recommended safety precautions.

Assertiveness Scripts: Now that you’ve reflected on what you need in order to feel comfortable, it’s time to share it with the other person. Let them know before you meet up, if possible, so that no one feels pressured, and then share your limits assertively. Here are the hallmarks of assertive statements:

Use the “I”: Generally, “I would like…” is more effective than “You need to…” Stating your needs directly acknowledges that you are asking something of the other person, and can preempt defensiveness. It allows Aunt Jean to be the person who meets your needs, rather than the one submitting to your demands. Note that saying “I feel you are…” is not stating your needs.

Be Specific: Words like “safe” and “careful” are vague, subjective, and value-laden. State the specific behaviors you’re comfortable with or wondering about.

Reinforce the Positive: By stating the positive outcome of their compliance with your request, it moves the conversation from one of punishment to one of gratitude.

Practice: It might feel silly, but if you practice beforehand, it will be much easier to say these prepared statements in the moment. Use these guidelines to speak into the mirror: “I’d like us to sit outside for our dinner, Aunt Jean. I really want to see you and I’ll be better company if I’m feeling safe.”

How to Say “No”: If someone makes a request that you do not want to comply with, then it’s time to practice your assertive “No”. If you’re in person, make eye contact and speak firmly. “No, thank you” is sufficient for a stranger. If it’s a relationship you value, you can offer an explanation as well as an alternative plan that works better for you. For example, “I’m not comfortable going to your birthday party because I’m not taking public transportation right now. I would love to have dinner over Zoom together instead.” Remember: the other person does not need to accept your no. If they keep pushing, use the ‘broken record’ technique, repeating a succinct version of your “no”. Try saying “I’m not comfortable doing that” three times, calmly in an even voice. It might sounds silly, but it is effective.

No Apologies: It can be tempting for people who are more passive to couch their requests or needs in apologies. But saying things like “Sorry I’m being paranoid, but…” undermines the legitimacy of your needs and opens the door for boundary crossing.

Accept the Consequences: Just as you have the right to say no, others have the right to not like it. Your aunt has the right to think you are being hypersensitive, entitled, hurtful, or dramatic! Recognize and accept that your ‘no’ may elicit an emotion from the other person. That doesn’t mean you don’t have the right to state your needs.

Accept Their No: It may be difficult to hear someone else tell you ‘no’. You might feel that the other person is the one being hurtful, judgmental, or hypersensitive! You may have the urge to cajole them, convince them, or defend your choices. While you have a right to your feelings, pushing back against the other person’s boundaries is aggressive behavior, not assertive behavior. Try and remember that we are all doing the best we can to find the balance between safety and connection, and that this balance is unique to each person.

Though it may feel unnatural at first, assertiveness is key to feeling both safe and connected. Boundaries in relationships are not a punishment – boundaries are actually an effort to maintain a relationship with someone, by making sure you enjoy seeing them, both in the moment and for the two weeks afterwards.

For scientific and up-to-date recommendations and guidance on what behaviors are safe, please refer to the CDC’s website (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html).

If you want to speak to one of our team members about asserting your needs at Therapists of New York, click here to book a consultation.

How to Choose The Right Therapist

Searching for a therapist may be the most challenging part of  therapy. Each part of the process presents obstacles that need to be overcome to proceed: 

• Motivation to start the search.

• Finding the time to look, research, read profiles, and identify candidates.

• Enduring cycles of searching and lethargy when no one appeals to you.

• The discomfort of writing the email or making the phone call once you identify the candidate.

• The feeling of rejection when they don’t take your insurance, they don’t have a time slot that works, or they simply never respond.

For good reason, this is not as simple as swiping right. While that approach may work well late on a Friday night, it’s not necessarily the person you want to trust long term. For therapy to be successful, you need to find the right match. The better way to get there is by identifying some glimmers of shared interests while reading through profiles or getting a referral from someone you trust. 

TRUST. SAFETY. SECURITY. COMFORT. These are the are some of the most important factors for the success of therapy, other than your own motivation. You need to find a therapist that you trust with your thoughts and feelings. A therapist needs to provide a feeling of safety so that you can be vulnerable. You need to have the security that you won’t be judged. You need to be comfortable with both the therapist and the space so you can relax and open up. 

Here are some strategies for identifying the right therapist for you.

BE HONEST WITH YOURSELF.

You should have some understanding of why you’re seeking therapy. You don’t need to understand the root cause of the issue, that’s what therapy is for. You just need to be able to identify the feeling or behavior: anxious, depressed, loss of interest, lack of focus, more introverted, etc. This will allow you to identify keywords in a filter search, or to describe in an email or on a phone call.

DO YOU HAVE A PREFERENCE?

Let’s face it, we are more comfortable talking to people similar to ourselves, especially when talking about uncomfortable topics. If you are 75 years-old and just lost your spouse, chances are you’re going to have a hard time relating to a 26 year old who is in the thick of the dating scene. Factors such as gender, race,  sexual orientation, age, etc. may play into how deeply you discuss yourself. If you worry about your therapist being biased, talk about it in therapy. 

DO YOU NEED A SPECIALIST?

Not all therapists are the same. Just like medical doctors there are therapists who are specialists. A therapist that specializes in addiction may not be a great fit for someone with an eating disorder. If you have a specific issue that you want to work on, try and identify a therapist with that specialty or interest. 

WHAT TYPE OF THERAPIST IS RIGHT FOR YOU?

A Psychotherapist is a general term that covers any licensed mental health professional. These licensed professionals are broken down into the following groups of education and licensure:

Ph.D. - A Doctorate in Psychology with training in clinical work (talk therapy) as well as psychological testing, and research protocols.

Psy.D. - A Doctorate in Psychology with training in clinical work (talk therapy) and psychological testing, but with less emphasis on research than a Ph.D..

Psychiatrist - A psychiatrist is a medical doctor (MD) having attended 4 years of medical school followed by a residency. Psychiatrists are able to prescribe medication. While some psychiatrists provide psychotherapy services, they are more likely to understand your feelings and behaviors through the lens of regulating brain chemistry.

LCSW - Licensed Clinical Social Worker - Achieved a Masters Degree in Social Work with a focus in clinical work (talk therapy) and can help patients find and obtain resources they need to improve or maintain a healthy lifestyle. 

LMFT - Licensed Marriage and Family Therapist - Achieved a Masters Degree in Marriage and Family Therapy with a focus in family and other relationships.

LMHC - Licensed  Mental Health Counselor - Achieved a Masters Degree in Counseling with a focus in clinical work (talk therapy). 

LPC - Licensed Professional Counselor - Achieved a Masters Degree in Counseling with a focus in clinical work (talk therapy). 

WHAT STYLE ARE YOU COMFORTABLE WITH FROM YOUR THERAPIST?

Are you analytic or conceptual? Do you want your therapist to be active or passive? In therapy, there are many different styles and techniques (termed modalities in psychology). Amazingly, they all work! But, they only work when you mesh with the style that is right for you. Having an awareness of the different types of therapy is helpful when selecting a therapist. From the descriptions, you can choose the type of therapy which you feel will be most effective. Below are a few of the primary modalities. 

CBT - Cognitive Behavioral Therapy - Believes that psychological issues come from patterns of unhelpful behavior and unhelpful thinking. A CBT therapist structures a therapy plan to change these patterns, which may include in session exercises as well as out of session “homework”.

DBT - Dialectical Behavioral Therapy - Provides patients skills to manage their emotions and decrease relationship conflicts. It is broken down into 4 skill sets: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

ACT - Acceptance and Commitment Therapy - Is an action oriented theory that grew out of DBT and CBT. Patients learn to accept that their feelings are appropriate for certain situations, and choose to make changes in their behavior to move forward, regardless of how they feel.

Psychodynamic - Focuses on a patient’s unconscious processes and how the manifest themselves in behavior. The goal is to increase a patients awareness of the past and how it influences the present.

Psychoanalytic - Focuses on exposing patients deep seeded memories, often unconscious or repressed, so that they may be examined in an understanding of how they influence present.

WHAT CAN YOU AFFORD?

Be comfortable with what you can afford. You don’t want to skimp, but the cost also shouldn’t burden as to make you evaluate the immediate return on each session. Remember that this is a long term investment in yourself. Appreciate that therapy is a long term commitment that typically is a minimum of 12 - 26 weeks. A therapist can help you understand your health insurance. You can also read our post on insurance. 

LOCATION, LOCATION, LOCATION

Your therapist’s office needs to be convenient so that you can arrive relaxed, and leave without feeling rushed. Therapy is supposed to be a safe place, so consider the getting and leaving there as part of your decompressing ritual. Most offices have a waiting room. Consider getting there 5-10 minutes early to sit, relax, and reflect. Another important component is the office setting itself. Are you comfortable in the waiting room and office? It’s a lot easier to relax when comfortable. 

5 Tips to Stay Mindful

Let’s face it, we are all feeling stressed right now. We are living in a time with many unknowns, inequalities, and mixed information. Future planning seems like a luxury from years past. At Therapists of New York, we are helping our patients (and ourselves) by enhancing strategies to reduce stress and improve focus and awareness. We asked our mindfulness expert, Dr. Rachel Diamond to help us with some quick tips on how to bring more mindfulness into our everyday lives. This is what she recommended.

1. Pause and check in with yourself

Take a moment to attend to what is happening for you right now. What are you feeling (happy, sad, joyful, etc.)? What are you physically experiencing, any sensations you notice (tightness, pulsing, throbbing, etc.)?  What thoughts are around (what are the things you are saying to yourself)?

2. Notice the things you are telling yourself

Take a step back. Be curious. See if you can distinguish what you know to be true in this moment vs. the stories that you are telling yourself. What can you change in this moment, and what can you not? By doing so, you can choose how you would like to respond to the stressful situation rather than automatically react to it.

3. Decide what you need in this moment

Perhaps you need to step away from what you are doing, even if it is just for 5 minutes. Take a walk, drink some water, or stretch – whatever it is, attend to it! It is an invitation to care for yourself – you deserve it. A little can go a long way.

4. Take a breath!

Taking a moment for a deliberate, slow, deep breath can trigger a relaxation response that slows it all down. By focusing on the breath (even just for one cycle) you can help bring yourself back to the present moment experience rather than stay consumed with worried, wondering thoughts. See if you can take note of your inhale and of your exhale. It’s a way to simply be with your breath, not trying to change or control it, but just being (present) with it. 

5. Notice what else is happening around you

Expand your field of awareness to all the things around you. What do you smell…see…hear…etc. Sometimes when we become so consumed with our thoughts in the moment, we don’t even notice what is happening around us. As the saying goes - stop and smell the roses! You may be surprised as to what you discover.

Feel free to do these steps in order, or pick and choose one at a time. Choose your own mindful adventure!

If you are interested in learning how to be more mindful, contact us here to get more info about Dr. Diamond’s weekly mindfulness group.

Pros and Cons of Telehealth in NYC

In the spring, therapists and patients in NYC were abruptly thrust into the world of telehealth. It was one of many adjustments we had to make among so many unknowns around us. After some clunky adjustments (poor wifi connections, frozen screens, scheduling changes, finding private spaces, etc), we made it to the other side. And the other side is…working! Some therapists who never considered telehealth are now moving their practices remote long-term. Others are watching the news intently for the moment that they can go back to the comforts of their office. Similarly, some patients have voiced a preference for remote sessions indefinitely while others are waiting to resume therapy because video simply does not cut it. After numerous discussions with our patients, many therapists in NYC and among the Therapists of New York team, we came up with a list of the pros and cons of using telehealth. If you have any more to add, feel free to email us at info@therapistsofny.com. We would love to hear your experience!

Pros

• No commute: Goodbye unpredictable obstacles like traffic and train delays!

• Neutral ground: No hierarchy! You are not a guest in your therapist’s office. You share the virtual space equally. That helps some of our patients feel more casual or less inhibited. 

• More flexibility when scheduling and traveling.

• Reduction in intimacy/less intensity: Some of our patients express that the distance allows them to feel more open and think freely. 

• Glimpses into our patient’s lives: Kids, cats, dogs, significant others, apartments, renovations, etc. When working remotely, we get visuals of our patients lives. It feels connecting in a whole new way.

Cons

• No commute: Some patients miss the mental processing that occurs during a commute. Also, there is less transition time between activities. Click off of a call with your boss and on to a call with your therapist. It’s intense!

• No waiting room: Our patients miss a space to get in the therapy mindset. Virtual waiting rooms just don’t cut it.

• Reduction in intimacy: The magic of face to face interactions is impossible to replicate over video. Even the passing of a tissue can be powerful in certain therapeutic moments.

• Just a face!: We miss body language, picking up on subtleties, the ability to avert eye contact more freely, etc. 

• Technical difficulties: Imagine a powerful silent therapeutic pause turns out to be a frozen screen! Those moments really mess with the flow.

• Screen-time fatigue: Staring at a screen all day is rough on our brain and body.

Telehealth has major strengths and has proven to be a convenient alternative to in person therapy. Although we miss many aspects of meeting in person (and can’t wait to have the option again) it is clear that telehealth works. If you are interested in starting therapy, don’t wait to meet in person. You can get insights, relief and support now thanks to telehealth. 

If you want to speak to one of our team members about starting therapy via teleheatlh at Therapists of New York, click here to book a consultation.

What To Ask My Insurance Company So I Actually Understand How Much Therapy Will Cost

How much will my insurance company reimburse me for therapy? This topic makes most people’s heads spin - for good reason! There is a lot to consider and it can be overwhelming. We made a list of questions to ask your insurance provider so you know the costs before you connect with a therapist. 

Start by calling the member hotline on the back of your insurance card and ask the following questions:

Do I have in-network mental/behavioral health benefits?

• If the answer is yes, you can see any provider that is in-network with your plan (e.g., if you have Aetna, you can see a provider who takes Aetna).

• In-network is more affordable than out-of-network. This is because in-network providers have agreed to accept a discounted rate for services in exchange for being part of the insurance company’s network.

What is my in-network deductible? 

Has any amount of my deductible been covered this year? 

What is my copay amount?

• You are usually responsible for paying a deductible for in-network services (usually $100-$2,000/year), and after that is met, you are responsible for covering only the copays (usually $10-$75/session). The therapists will be reimbursed the remaining balance directly by the insurance company.

Do I have out-of-network mental/behavioral health benefits?

• If you can afford to pay more for your therapy and you have out-of-network coverage, you have access to MANY more therapists in NYC. With out-of-network benefits, you will pay more, but you can choose any licensed therapist you’d like to see and your insurance company will reimburse you for the costs. Out-of-network therapists in NYC charge between $100-$500/session. 

• A plan that includes out-of-network benefits is usually referred to as Preferred Provider Organization Plan (PPO) or Point-Of-Service Plan (POS).

Do I have an out-of-network deductible that has to be met first before I get reimbursed? Has any amount of my deductible been covered this year? 

• Out-of-network deductibles can range from $100-$10,000/year.

• If any amount of your deductible has been met, you will only be responsible for meeting the remaining amount. For example, if your out-of-network deductible is $3,000 and you have already seen an out-of-network provider for $1,000 of services, you will only need to pay for $2,000 of therapy sessions before receiving reimbursement.

What is my co-insurance amount? 

• Co-insurance typically ranges between 20%-40% of the session cost. Co-insurance is the amount that you pay out of pocket - without reimbursement - per service after your deductible has been met. 

• For example, if the cost of the session is $200, you will be reimbursed between $120-$160/session by your insurance company.

What is the usual and customary rate covered by my insurance for outpatient psychotherapy (CPT code 90834)? 

• This is the million dollar question! Insurance companies do not reimburse just any old cost that your therapist charges. They will cover a X% amount of what they deem is acceptable for a therapy session in NYC - this is often referred to as “customary rate” or “allowable amount”. Each plan in each insurance company “allows” a different amount. 

• At Therapists of New York, we have seen allowed amounts range from $60-$250/session, with the average being $180/session. This means that if your co-insurance is 30%, your insurance company will reimburse you 70% of $180 (the allowed amount), even if your therapist charges $200/session. So let’s calculate: 

• You pay your $200 for a session.

• You or your therapist send a bill to your insurance company.

• Your insurance company decides that they will “allow” $180/session

• Your co-insurance is 30% so your insurance company reimburses you 70% of $180 (= $126). 

• In a nutshell, you pay $200 and your insurance company sends you a check for their part, which is $126. Your out-of-network therapy will cost you $74/session. Not bad for high quality therapy from any provider you want to see in NYC! 

If you want to learn more about insurance, check out our blog Simplifying the Baffling World of Health Insurance. If you have any questions about how much your insurance company will reimburse you for services with Therapists of New York, click here or email us at info@therapistsofny.com.

Questions For Your Initial Therapy Consultation

You spend months thinking about starting therapy. The search for a therapist is time consuming and unsatisfying. There are false starts and missed connections. Finally, you find a therapist that can work. Reading their profile, you find thoughts and phrases you can relate to, and their approach to therapy speaks to you.

Now it’s time to reach out to the therapist.

EMAIL THE THERAPIST

Your time is precious. Therapists are busy. Email for both of you is the easiest way to communicate. Make sure to clearly address the following in your email:

• Scheduling - Let the therapist know what days and times are convenient for your weekly therapy appointment.

• Fees - Ask the therapist’s per session fee.

• Insurance - See if the therapists accepts your insurance.

• Location - Confirm the therapists location.

If one of these conditions is not going to work for you, then it’s best to move on. You can ask for a referral.

Otherwise, if you can make these 4 things work, ask to set up an initial consultation phone call.

YOUR CONSULTATION PHONE CALL

The following is not intended to be a script. These are just some guideposts to help you along the way. Every call with a therapist will go in a different direction. Many therapists will start off with some version of “So why are you calling? What’s been going on?” In every case, this is supposed to be a fluid introductory conversation. Expect the call to take no more than 15 minutes. Find a comfortable time and place, and don’t feel rushed.

CAN WE CONFIRM THE FOLLOWING?

When talking with the therapist on the phone, confirm the information in the email.

Scheduling - The date and time needs to work on a weekly basis. If not, try and find a weekly day and time that works for you both. If scheduling doesn’t work, then ask for a referral. Make sure you can consistently attend every week, and some therapists have a cancelation fee.

Fees - What does the therapist charge for a weekly session? What payment do they accept? Some therapists have a sliding scale depending on your financial situation. You should be open and transparent about your comfort with fees. Consider this to be a 12 week minimum commitment. Ask about the therapists cancelation policy.

Insurance - Most therapists will not deal with your insurance. They leave the whole headache up to you (We take care of this for you at Therapists of New York!). It is to your benefit to contact your insurance carrier to understand your benefits. For a complete guide to insurance. Click Here.

Location - Get clarity on the following: Address; nearest subway, bus, or parking lot.

TALK ABOUT WHY YOU ARE SEEKING THERAPY.

After the basics, it’s now time to talk about why you are calling. This is just a high level overview to describe feelings, recent experiences or troubling behavioral patterns. There’s no need to analyze details of your life. This is a big picture conversation. Where you can both determine if you click.

DO YOU HAVE ANY SPECIALIZATIONS?

Many therapists are generalists. They see all types of patients with various treatment goals. Yet many also have specialties or interests that they are extra suited to treat. These specialties may range from eating disorders, to addiction, to couples, to grief. Ask about specialties, especially if you have specific issues you want to work on in therapy.

DO YOU HAVE A STYLE?

Thankfully, therapy is not one size fits all. There are different styles of therapy which have grown out of theories of thoughts, emotions, and behavior. While some therapists can move between styles, most have a default where they are comfortable. Ask what their preferred style of therapy is, and how that looks in a session. Ask yourself if their style is what you have in mind, and if you think it will be helpful.

HOW DO YOU WORK?

There are many ways to answer this questions. They may focus on actionable goals or support or gaining a deeper understanding of yourself. Their response can help you to gauge if you are a good fit. Does their answer feel like they are aligned with your goals?

WHAT DO YOU THINK THE LENGTH OF TREATMENT WILL BE?

Therapy takes time. It’s not as simple as take 2 aspirin and call me in the morning. At the most basic level, you and your therapist need to do a little cerebral or behavioral rewiring. This takes time to be effective. Research shows that 26 sessions seems to be a sweet spot. Many people find that they like therapy as a safe place they can open up and talk, and choose to stay in therapy for years. It’s up to you and your therapist.

HOW LONG IS A SESSION?

Most therapy session run between 45 and 50 minutes. Couples or family sessions are usually 60 minutes. Confirm with your therapist.

SET UP YOUR WEEKLY APPOINTMENT

If you’re satisfied with the conversation, then set up an initial appointment. Get there a bit early sit back, breathe deeply, and relax. Allow the therapist to guide the session. If you feel awkward or uncomfortable during the session, let the therapist know so they have a chance to get it right. If it still feels off, move on to someone else. Trust your gut. It should feel right.

Simplifying the Baffling World of Health Insurance

In Network. Out of Network. Copays. Co-Insurance. Out of pocket. Reimbursement. Deductibles.

As therapists we have been doing this for years, and we still get tongue tied. Once you understand the concepts and definitions, you may find you can afford premium healthcare.

One of the biggest hurdles is understanding your mental health benefits. Not all health care plans are the same. Different plans allow for different coverage. Some plans do not cover mental health services, but most do. Before you start therapy, it is important that you understand the costs so that paying does not hinder your ability to attend regularly (keep that momentum going!). You can find information about your particular benefits by signing into your insurance carriers website, calling the member hotline (found on the back of your card), or contacting your HR Department. Click here for questions to ask.

You also need to verify if your mental health coverage includes out-of-network benefits, or if your coverage limited to only in-network coverage. If your plan does not cover mental health services, then you will need to pay for therapy out of pocket. If your health care plan allows for only in-network therapy, your therapist will need to accept your insurance or you can choose to pay out of pocket. Verify with your therapist if they are an in-network or out-of-network provider.

If your plan allows out-of-network mental health care, then you can see a therapist of your choice. In most cases, you will need to pay for the entire therapy session upfront and out-of-pocket. You will then be responsible for submitting an insurance claim to your insurance company for reimbursement. Generally speaking, you will only be reimbursed a portion of the total cost, anywhere between 25% and 80%. For example, if a session costs $200, you will pay your therapist $200, your therapist will send you an invoice, you will either mail the invoice to your insurance carrier or upload the invoice to your insurance carrier’s website. Finally, they will mail you a check for between $50-$160. It sounds complicated but once you do it once, it is relatively straightforward.

Let’s get into specifics.

Generally speaking, there are 3 types of insurance:

HMO (Health Maintenance Organizations) - Only provide in-network healthcare services. As part of an HMO, you need to designate a primary care physician (PCP). This physician is your gate keeper, and needs to approve you to go and see another healthcare service such as a therapist. This therapist must be in network to be covered by your insurance. This is the most restrictive type of health care plan.

EPO (Exclusive Provider Organizations) - Only provide in network healthcare services. With EPO you generally do not need a primary care physician (unless your plan in “gated“). You can seek out additional healthcare services on your own, such as a therapist. This therapist must be in-network to be covered by your insurance. This is less restrictive than HMO health care plans.

PPO (Preferred Provider Organizations) - Provide in-network and out-of-network health care coverage. Out-of-network coverage has a higher out of pocket cost, but PPO’s will cover some portion of it depending on your plan.

POS (Point of Service Plans) - You need to have a PCP, but they can refer you to out-of-network health services. Some portion of the expense may be paid by your insurance company, depending on your health care coverage.

Below is a list of all the terms to help you understand your healthcare benefits.

PREMIUM - The amount you pay the insurance company each month to have health insurance.

DEDUCTIBLE - The total amount of money you have to pay out of pocket before your insurance benefit starts. Typical deductibles are between $500 and $5000. So let’s imagine an in-network therapist charges $100 per session, and your deductible is $500. You would have to pay your therapist $100 for 5 sessions out of pocket, before your insurance company would begin to pay.

IN-NETWORK - This refers to therapists that are covered by your insurance plan. Insurance companies typically dictate the fee that therapists can charge their patients.

OUT-OF-NETWORK - This refers to therapists NOT covered by your insurance plan. Your insurance plan may still provide some coverage for out-of-network therapy.

COPAY - This is the amount of money that you owe every time you visit your in-network therapist. It is typically between $10 and $50 per visit.

OUT-OF-POCKET - The money that you need to pay directly to your provider.

REIMBURSEMENT - This is the money that your insurance company repays you after you pay your therapist in full. Typically this occurs for out-of-network therapists that do not take insurance. You pay the entire session fee yourself out-of-pocket, then submit an insurance claim to the insurance company to get reimbursed for the out-of-network treatment. This only works if the your insurance plan covers out-of-network therapy.

PCP (Primary Care Physician) - Doctors that act as the gate keepers to other health services. In the cases of plans where a PCP is required, you must have them “OK” you to see another healthcare professional.