Comments on
3 Psychotherapy Myths: Clinic Vs. Private Practice

By Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Sure, there are drawbacks to seeing therapists in a clinic setting but there are also benefits.

16 Comments to
3 Psychotherapy Myths: Clinic Vs. Private Practice

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  1. I found the therapists in the government operated clinics were far superior to the private ones that I went to.

    Standing ovation for all the exceptional therapists who really have compassion for the people they treat – mine helps me get through the day.

    • Glad to hear that! Are you located in Canada? U.S.A.?

  2. When I was first diagnosed 11 years ago I was treated by my GP and saw a therapist (short term) through my EAP program at work. After several relapses, occupational health wanted an opinion from an independent psychiatrist who recommended a medication change, supervised by my GP. Unfortunately, decreasing one antidepressant in order to make the change to a new one resulted in a 13 day hospitalization. The hospital psychiatrist put me on a totally different med, got me stabilized and released me with instructions to follow up with my GP. She thought it would be a good idea for me to see a psychiatrist for counselling to help me get back to work as well as med supervision. What a nightmare that was – 1 offered an appointment in 8 months, another said he be happy to see me but only after I’d returned to work! Very frustrating for both me and my GP.

    My GP then suggested I call the Mental Health Access line. This is funded by our provincial health services department. Through them I was provided access to a therapist (for counselling) and a psychiatrist (to manage meds). I have been attending this clinic for the past 8 years and even though my psychiatrist has changed a couple of times and my therapist once, I have had nothing but excellent service from them and all the clinic staff. They also run outpatient programs teaching among other things, CBT skills and mindful meditation, both which I participated in and found very helpful. The bonus – all this is covered by my health care plan and I don’t have to pay anything extra! Only in Canada!

    For me the psychologist I see is one of the best I have seen and I’m lucky to be able to continue to see her as long as we both feel it necessary.

    • Waiting times in Canada (despite other advantages), are an enormous disadvantage that I keep hearing about from many Canadians.

  3. I see my therapist in private practice. He is excellent. However because he does not have any office staff I must deal with him directly in matters of payment and insurance. I have complex PTSD and issues with attachment, trust and abandonment fears. At one point after about a year of therapy it looked like I might loose my insurance. My therapist assumed I would not continue in therapy due to costs and began to talk about terminating. I was devastated and took it as he cared only about money and not me as a person. Anyway, to make a long story short it had a huge impact on our relationship. In a clinic there would have been some buffer and probably some more options (like a sliding fee scale) as well as who I was dealing with. In all likelihood the therapist would have been unaware of the financial arrangements so I would not have taken it as a direct rejection by my therapist. Just my two cents. Something that never occured to me when I started therapy!

    • @Judy That is an excellent point. It brings up other issues and questions including what obligations a therapist has to continue working with a patient and/or helping the patient find other options because the patient’s financial situation has changed. Without knowing any of the details, I cannot say how the events transpired, but there are moral and ethical obligations a therapist has to his patients.

  4. I’m in Canada.

    If you are seeing a psychiatrist it is paid for by our health system and doesn’t usually take quite as long – in my experience – to see one. However, it does not cover the cost of psychologists but will cover the cost of MSW’s for short term therapy – the problem getting to see someone is the wait time – about 3 months. The good news is that if you are not improving you can get another referal from your doctor to continue your treatment and this has been such a relief – because that is where I am – on my second round.

  5. until my current situation i’ve always seen therapists in clinics – in cramped, sterile office “cells” with barely enough room for two chairs and a desk. when i switched to the therapist i see now i was fortunate enough to find someone in private practice(paid by government insurance). i now have therapy in a large, airy, renovated “hay loft” (for lack of a better term). there is room to breathe. the whole experience is less clinical and sterile and in my opinion more condusive to healing. i am not saying therapists are better or worse in clinics, such generalizations are impossible to make, just that, for me, this new environment is so condusive to healing – i love it, and it is something someone trying to find a optimal therapy situation might want to consider.

  6. The therapy clinic I go to charges a fortune and isn’t in-network for any insurance… I have looked into several that do it. Granted I go to a specialized clinic for my problem. They know they are in demand to figure they can charge whatever they want, I suppose. (also are located in a posh area). So most of this doesn’t apply to this situation. However they do have a billing person that will bill insurance for you and many patients do get some insurance coverage, I’ve been told.

    The advantage to a clinic is that the therapists there do have some oversight. At the very least if you have complaints there’s someone you can go to. Also, if you decide that you don’t like the particular therapist you are seeing, or your therapist leaves, it’s significantly easier to go to another therapist in the clinic then it would be to start back at square one.

    Granted, there’s a HUGE difference between a “community mental health center” and a private clinic, both in terms of overall quality and price.

    • @LS. It is good to hear that you are having such a helpful therapy experience. Although I have not had the pleasure of working at a community mental health clinic, I do know several excellent therapists who have. Sure, the setting (the posh furnishings, the well-groomed receptionist, etc.) will be nicer at a private clinic, but it isn’t necessarily so that therapists at private clinics are better. There are wonderful therapists who are committed to serving a disadvantaged population, for example. Also, the reverse is true. Please read chapter 7 of my book Therapy Revolution, which contains interviews with patients who have had negative therapy experiences with therapists across the practice spectrum.

  7. Also, the advantage for a therapist is that it’s a bit cheaper and easier for them. They don’t have to hire their own clerical staff and rent their own office. Also, it seems like working in a clinic would be preferable if you are worried about the social isolation that can come from having a private practice.

  8. After I called Access Mental Health, I had an intake interview within a week and was seeing a counsellor the next week. Maybe that’s an exception to the norm.

  9. I assume that you’re speaking of private clinics in this article, because my experience with public mental health care is completely different. It may be perfectly good for people anywhere else, but in Georgia, at least, it is substandard at the very least.

    In the state of Georgia, the public mental health system has been fined and sanctioned by the U.S. government due to the number of patients who have died in the public mental health hospitals. The state hasn’t really bothered to do anything in response because the state legislature hasn’t put any money in the budget TO respond with.

    The clinics that feed into the hospitals aren’t any better staffed and don’t provide services any better than those hospitals. Their only saving grace, if you can call it that, is that patients aren’t locked up with other patients.

    I’ve had several periods in my life when the public mental health clinics were the only way I could get any treatment at all for disabling problems, so I went. It was extremely difficult to do so, especially since I experience depression, anxiety, agoraphobia and PTSD. But I went, because I did want to get better. It seemed then, and even now looking back (and observing other people who are having to get treatment there now) that they make it as difficult as possible to get any help at all.

    From their conversations and angry outbursts in the waiting area, many people are only present for court-ordered treatment or testing. It isn’t as if the clerical staff give even lip service to confidentiality, either. The feeling I got from all of the staff, therapists included, was that anybody who was in treatment there should feel grateful for being able to get treated, and be made to pay somehow – a very Calvinist ethic that isn’t uncommon in the south, something that hearkens back to a Victorian notion of poorhouses and so on. If you need help, you don’t deserve it.

    In one county I was just told bluntly that there wasn’t any therapy available. Not group, not individual – nothing. I saw a doctor every few months who talked to me about whether or not I was taking my medication as directed and that was it. There were no lab tests to check on whether those same medications were damaging my internal organs.

    After a year I went to refill my prescriptions and was told that I couldn’t get my medication because I was non-compliant, which I couldn’t understand. Apparently there was a standard treatment plan that required participation in individual and group therapy (which, remember, wasn’t available) and regular meetings with a case manager (who I’d never heard of), and of course I’d never done any of that, as I’d never seen or heard of the treatment plan – although someone had forged my signature on it.

    So I had to go without my very high dose of 375mg of Effexor daily very suddenly, while trying to figure out this Orwellian puzzle and figure out who the mythical case manager was (no name for her on the plan) and get an appointment with her. One was finally assigned to me after over a week, and I was informed that I had been “worked in” to her schedule – in 3 months. During which time I would have no medication.

    That business seemed tailor made to put me in the public mental hospital, a place I feared terribly even though this was several years before the investigative journalism that revealed the deaths and secured the federal sanctions. It was eventually straightened out, but doing so required that two other people take time off from work to go to the clinic and advocate very strongly for me, because I was completely incapable of coping with anything after a couple of days.

    The bad news is that this county was better than the one where I live now. I don’t think I can even start to tell everything that has gone on in the clinic nearest my home here.

    This county has therapists available – sort of. You just never know who you’ll see for an appointment, and appointments are changed constantly, sometimes without notice to the patient. You arrive for an appointment and are told, “Oh, that was changed.”

    If the appointment is taking place as scheduled, you get into a room (some room, you never know which it will be – just an ugly little office) with somebody you might have never met or heard of before. That doesn’t actually count as therapy as far as I’m concerned, because there’s no way to build any kind of trust or therapeutic relationship. There’s no chance of planning or having any consistency.

    I can say that I am very glad that I have Medicare now, and while it isn’t easy to find therapists who take Medicare (or to pay the 40% of their fees that isn’t covered by Medicare) that I am able to find care somewhere other than in the public mental health system.

    • @depressedinga
      That is disgraceful indeed. I have had good reports from community clinics in NY State, Pennsylvania, and several other states. I am not really sure about state-run clinics.
      I do have concerns about the situation with federal insurance programs, but that is a whole other issue. Sadly, I am not surprised to hear about what you’ve experienced-I do think that community clinics (towns, cities, community orgs.) do much better, in large part because there aren’t quite so many hoops to jump through.
      What you went through sounds really horrendous-I am so sorry to hear of your difficulties. I wish you success.
      RMZ

  10. The quality of therapy you receive depends on the doctor. When I first went to the clinic I had a terrible therapist. She had never done this before and I felt like she didint like me. I was telling her about my obsessive thinking and she told me she never met anyone like that before. I felt like a hopeless alien. And then when I told her my boyfriend and I argue all the time and I asked her what do I do she said stop arguing. Ok, so I did and I felt suicidal because I didn’t know how to effectively communicate my feelings to him and she didn’t help. I remember telling her about school and how I couldn’t concentrate on my homework or class work and she said in college she didn’t do her homework either because she had the same problem. I was thinking ok… Not helping. I asked her why she wanted to be a therapist to see what she would say and she said to help people. And I thought to my self, ok you need a better reason because if you don’t help the person you are trying to its going to take a toll on you emotionally. Your putting yourself in a position to be responsible for other peoples happiness. It can be self destructive. So I asked her what is a therapists job and she said its to listen to other peoples problems so they can get it off their chest and have it roll off her…. She said like a wall. And that’s what I talking to, a wall. She recommended I move on because she felt like I was ready to because of a few weeks of mania in my bipolar disorder. So I stopped. A year later I went back to the same clinic because of depression and Got a new doctor praying for a good one. She was incredible. And if you’ve had a terrible therapist you really appreciate the good ones. I could trust her, she listened. She didn’t just sit there as I talked, she asked me questions about how I felt, threw different scenarios at me, helped me practice positive self talk, helped get me organized so I can remember to do stuff, and helped me find my strengths. She reflected back to me my body language to prompt me to tell her what I was thinking if I was comfortable. She helped me realize it was my responsibility to find my own happiness and not my responsibility to take care of everyone else. It was the best thing Ive ever done. So my advice would be, give it a chance. If you have a terrible therapist request a new one. Because you wont know how it may change your life until you try it.

  11. i had a problem with my knee when i was 21, a bakers cist and i went to the local clich to get psycsitherapy on it, the women that was seeing me for the 15 minutes, was also at the same time dealing with 4other patients,in beds aline to mind there was no discussion between us, i just lay down and on she went her way, i would have a complainted but i looked around and could see the situation the person was in… she give me the all clear and i went out and hurt my knee immediatly afterwards… so i decided to go private, and the person sat me down for an hour and explained all the different things it could be and what not a whole pile of different excerises,
    i learned from this experience private indivduals have more incentive and time to deal with your problems propertly,
    this lesson lead me to pick a private counsellor for my therapy, woefully is the nicest word i can use to descide his actions, beliefs and level of care.
    So I learned another lesson, weather private or in a clinic it doesnt matter, in both sectors there will therapists who will do there job properly and therapists who will not do they job propertly,

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