Or maybe you’re a bundle of nerves. You are so anxious you just want to hide. You’re nervous about your job. You’re scared to speak up even when you know you should and could. You are so anxious that you are anxious about being anxious.

Or maybe the issues are about relationships. You don’t have one or the one you have isn’t the one you want. You and your partner are fighting all the time. Every day seems to be “same fight, different day.” Trust has become a huge issue. Neither one of you can relax into your relationship. You each wonder where the love and sweetness and tenderness have gone.

And then there are family issues: The mother you can’t get along with. The father who expects too much or too little of you. Siblings who are mean-spirited, favored, or so self-centered that you feel constantly taken advantage of. Parents who are fighting. Parents who are splitting. Family you are expected to like but who are entirely unlikeable – and here comes another painful family event.

Any of these types of issues can stretch a person beyond his or her ability to cope. Any of them can challenge the most creative, caring, and responsible person, You’ve tried your best. You’ve tried to look at a brighter side, to be rational, to be smart about whatever it is. But you still can’t figure things out. You still feel alone in your troubles and without the inner resources or the outer supports to change things. This is when people often go to therapy. You wish you could. But you have no insurance and you know it can be costly. The situation seems hopeless.

It’s not. Serious, yes. Hopeless, no.

Inexpensive and Alternative Treatment Options

There are many ways to get the help you need, therapist or no. Before you give up on the idea of getting some therapeutic help, consider these alternatives.

Sometimes therapy is free or low-cost.

Depending on your problem, there may be funded or subsidized therapy available to you. Many communities have women’s centers that offer free services to women who are being abused. Many have free services for adolescents. And an increasing number of communities have men’s resource centers to help men with anger management, relationship or vocational problems. Go online and check.

Employee Assistance Programs (EAP).

Many businesses and companies offer a limited counseling benefit. Usually the company provides three to six sessions. If you need further help, the counselor will refer you to a local therapist. Check with your human resources department to see if there is an EAP counselor at your workplace. Often even a couple of focused sessions is enough to offer some relief.

Sliding scales and free slots.

Many mental health clinics and many therapists in private practice have sliding fee scales so that people can pay what they can afford. Ask your doctor if he or she knows who offers this service. Call some of the therapists in your area and ask. Many therapists keep a number of slots at a lower rate as their way of giving to their community.

Support groups.

Often a support group can be very therapeutic. By talking to people with a similar problem, you will feel less alone. Often there are people in the group who are a little ahead in their healing and who can offer you good practical advice as well as emotional support. Local hospitals, libraries, churches, and schools often offer support groups for grief, parenting issues, managing chronic illness, etc.

PFLAG (Parents and Friends of Lesbians and Gays) offers support to those supporting family members and friends who are coming out. There are also support groups online and in the community for gays, lesbians, and transgendered people who need information and advice.

Parent education classes.

Not all problems are mental health issues. Parenting is difficult. Often people new to parenting or new to a stage of parenting could just use some additional information and the reassurance and advice that can come from parents who have been there and done that. Often such groups are offered through the school system or through local parent centers.

12-step Groups.

Alcoholics Anonymous, Al-Anon (for families of problem drinkers) and Alateen (for teenage family members) offer support to people who are struggling with alcoholism and to their families. Other spinoffs include Overeaters Anonymous, Narcotics Anonymous, Clutterers Anonymous and Parents Anonymous. If you think a 12-step program is for you, search your issue and “anonymous” and you are likely to find a group.

The National Alliance on Mental Illness (NAMI) has chapters throughout the U.S. They often offer support groups for those struggling with mental illness as well as for family members.

Online support groups.

Name a problem and there is probably an online support group for it. Here at PsychCentral, there are over 100 such forums and groups. Members are not professionals. They are people who are grappling with the same issue you are. Their compassion and understanding can help you feel less alone. Often members offer experience and wise suggestions.

Are you a veteran? Every branch of the service has a program for military personnel and their families. Call your local Veterans Administration office for information.

Are you a teen? Many high schools have free counseling available through the guidance department. Often the guidance counselors are themselves counselors and can be very helpful with both individual and family problems. Sometimes they know which therapists in town have free or nearly-free services and where you can go for further help.

Are you in college? Check to see whether the health services at your school include a mental health department. Often the health insurance you pay for at school can enable you to see a local therapist for at least a few sessions.

Hotlines and warmlines.

There are important hotlines and warmlines in almost every country. In the U.S., the National Suicide Prevention Lifeline (1-800-273-8255) is available 24/7. The Boys Town National Hotline is also available 24/7 for teens (girls as well as boys). Google “hotline” and your problem and you are likely to find a number to call.

Houses of worship.

Spiritual leaders often have had training in counseling as well as in the practices of their faith. See if your church or synagogue or house of faith offers such help. If your spiritual leader isn’t comfortable dealing with secular problems, he or she may be able to refer you to someone who can.

Journaling or writing letters you will never send can be an important method for self-help. Don’t get put off by having to put something down. You’re the only one who is going to see it. Writing out what troubles us often helps us put our feelings into perspective. Often enough, a solution will come as you work to make your problems clear.

Bibliotherapy is a fancy name for reading a book. Whatever your problem, someone else has probably written about it to share their journey of healing. Sometimes we learn best from reading how someone else did and did not address issues. Search for your issue at one of the major online bookstores and you can find what you are looking for.

Prayer, meditation, chanting.

Anything that helps you relax and get out of yourself for a bit can do wonders for your state of mind. Turning your problems over to God, your higher power or the universe can help relieve the pressure and begin the healing.

Get off the screens and go outside.

Mother Nature is a great therapist. Stop spinning about your problem with online friends who are in the same spin and go for a long walk instead. Open your senses to the outdoors and you may be able to cut your problems down to a more reasonable size.

Talk to a trusted friend or family member.

You know who they are. Many of us have a friend or relative who is wise and loving and supportive. Don’t waste your time on anyone else. People who are critical or judgmental will make you feel worse. Reach for the people in your life who will listen with their hearts and who will validate your strengths.

Take care of yourself.

Getting enough sleep, eating right, and making sure you get a little exercise each day can do wonders for your troubles. You may not feel like doing any of it. But doing it, whether you feel like it or not, can help you start to feel a bit better. You will have taken a step toward self-care and self-love that is the basis for any therapeutic action.

Throughout the book, Spielman discusses topics such as marketing, time vs. cost comparisons, attracting your ideal clients and keeping them coming back. The purpose of her book is to provide a readable, concise guidebook to starting your own private practice. Spielman succeeds in this goal. She creates a book that is free of complicated philosophy and instead provides solutions that are accessible to everyone, business degree or not.

Spielman spends a large portion of the book discussing marketing strategies. I found this part of the book extremely helpful and important as it provides the reader with a place to start. Starting a business is an extremely monumental task and yet, Spielman manages to teach you how to set the foundation for your business in a way that does not seem scary or impossible.

Spielman includes several techniques that I would have never thought of on my own and I feel that this will be the case for many others who read her book. While Spielman always presents the information in a non-threatening, simplistic way, she still manages to bring new, exciting techniques to the playing field. She discusses everything from creating your marketing materials to choosing a business name to deciding which Internet listings you want to put yourself on. Her marketing strategies are extremely thorough and helpful to the person who may be just starting out.

Spielman then goes on to discuss what to do after you have your marketing strategies in place and begin to reap the benefits of doing so. She attends to every detail of the first communication with a potential client, including letting them know they are calling the right place, emphasizing your uniqueness within the field, bringing diversity to your approach, returning phone calls and emails promptly and how to bill efficiently. Next, Spielman addresses the scenario of spending too much time for not enough money. She includes a detailed list of tips on “how to save money and increase your bottom line at the same time.” Additionally, Spielman includes a section on how to deal with clients and non-payment.

In the last half of the book, Spielman discusses the ins and outs of attracting your ideal clientele. She takes the reader through the processing of ascertaining who their “ideal” client is and then closes by briefly discussing different types of clients: clients covered by insurance, self-pay clients, and more. Spielman then includes a chapter on how to keep these clients coming back. This chapter is extremely helpful and Spielman’s tips are, once again, new and exciting, yet presented in a manageable and accessible way.

Overall, my review of this book is highly positive and I greatly recommend this book to anyone who is thinking of potentially going into clinical private practice, or starting their own business. Spielman emphasizes that a business degree is not necessarily needed in order to have a successful practice. Her tips help the reader feel educated and aware of what steps they will need to take in order to begin their own journey of starting a private practice.

The Blueprint for a Successful Practice
By Gina Spielman, LCSW
CreateSpace: November 28, 2009
Paperback, 196 pages
$25.95

My first complete week without health insurance. As I still had hope I would be on Commonwealth Choice for February, I started researching when the last day of the current month is that you can purchase insurance for the following month. I want to hold out as long as I can before buying February coverage because I am hoping to have gotten Commonwealth Care by then.

However, this information is nowhere to be found on any website. I did find out though, that there is a 63-day, legal grace period for people like me who have lost their health insurance. You have up to 63 uninsured days before you incur a tax penalty with the state. I find 63 days to be an odd time period, but whatever, I’ll take it.

Also that night, I went to Target to pick up two prescriptions. I was prepared to pay full price for them. At Target, I am given the best news of my day when I find out that my auto-refill prescriptions processed through on 12/28 and were therefore paid by my old health insurance. Score! I also find out that one of my prescriptions is $70.99 without insurance. That is a lot more than I thought it would be. The pharmacist suggests that I get some health insurance. She means well, but really? Gee, thanks for that tip. I hadn’t thought about getting myself some health insurance.

1/8/10

I still have not heard anything, so I decide to call and check on the status of my application.

Call One: It takes three weeks to process an application, let me transfer you to MassHealth so you can check on your status. As I have applied for Commonwealth Care, I’m not sure why I have to talk to MassHealth. At any rate, I was transferred, then hung up on.

Call Two: I called back, pressed different numbers, then got to a person. The customer service person told me that my application was received on 12/17 and is pending. I am told it takes 45-60 business days to process an application and what I should have done was go to one of their ‘in person’ sites to apply. Apparently, when you do it in person, you can get processed in 15 business days. I am told that I can still do this if I want to reapply and try to speed up this process.

The thought of filling out the paperwork again is unappealing. I explained that a previous operator told me I couldn’t apply in person and that was why I had applied by mail. This operator again tells me I could have. I also explained that another operator was adamant that it takes 25 days to process an application, not 45-60 days. This operator tells me this information was wrong too. I pointed out that I continually receive conflicting information and no longer know what is correct and what is not. I understand that this particular customer service rep can’t do anything to change the situation, but it needs to be said.

I ask if I should go ahead and purchase health insurance for February because there may be no way my application will be processed in time for coverage. The customer service person tells me there is a chance, but nothing is guaranteed.

The more I thought about this “nothing is guaranteed” thing, the more nervous I got. I went ahead and bought myself an individual health insurance plan for February. Yes, I am getting decent insurance in relation to what it will cost, but it’s still an extra $224.83 every month. This is one of the lowest cost options, but the premium price will still cost me around a week’s salary. Ouch.

1/15/10

Still no word from the state about my application. I was feeling glad that I picked up some insurance for February.

1/19/10

A sad day for health care in the United States, as Scott Brown is elected to take Ted Kennedy’s Senate seat for Massachusetts. Health care was the hot button topic for Brown during his campaign and he has vowed to block Obama’s plan. As this is a subject that greatly affects my life, I spent four minutes watching a video on whitehouse.gov to ensure I fully understood Obama’s current proposal. Apparently the rest of Massachusetts does not and the majority voted for Brown. I fail to see how anyone other than the big health insurance companies can oppose Obama’s plan.

1/25/10

I received a large packet in the mail telling me that I am eligible for Commonwealth Care! This is good news, but I’m not sure how good. Commonwealth Care provides some kind of subsidized health insurance, but I have no clue how subsidized it is. The letter told me that I need to call or go online to enroll myself. I decided it’s probably best I do this over the phone, but it’s after business hours, so I can’t do it today.

P.S. – The packet I received is so large because it contains information on appealing decisions via a fair hearing, as well as a section on what to do if I don’t speak English and can’t read the letter. The instructions appear in 10 different languages. As this process has been excessively difficult for me, a native English speaker, I’m glad they provided this information for non-English speakers.

1/26 – 1/27/10

I have not been able to call during business hours to find out more information. I’m still wary that Commonwealth Care will really not be all that helpful.

1/28/10

Today I had time during business hours to call and find out what the deal is. I got fantastic news! The Commonwealth Care people told me I had been approved for a “Type Two” plan. I have no clue what this means in their world, but for me, it means I get super-subsidized insurance and fantastically low co-pays! I’ll now be paying a lower premium than I did when I got insurance through my employer and it sounds like I will get much better coverage! For once, being classified as “working poor” has helped, rather than hindered! Amazing!

It took a couple hours for this to sink in. Now, I feel like I can breathe again.

This process has been absolutely ridiculous, but in the end, it was worth it. I just worry about people who do not have the resources I do to navigate this system – the Internet, cell phone minutes, native English speech, and the ability to read and understand all the forms. What happens to people who do not have these resources during this process? Do many of them get help or do they give up? Massachusetts’ law means well and I greatly appreciate being accepted into Commonwealth Care, I just wish the process had been less painful. I doubt everyone who needs the service makes it through the process.

I live in Massachusetts, which I believe is the only state where it is illegal to not have health insurance. When I lost my health insurance, it was not an option to go without. As my salary is low and insurance premiums are high, I had to figure out what to do.

12/8/09

Today is the day a representative from my company’s new health insurance provider is coming onsite to enroll us. I knew that I was technically no longer eligible to be on the company’s group plan because I have not been meeting my sales quota. However, the company is far from on the ball and I’ve been able to stay under their radar. Because of this, I had high hopes that the company’s disorganization would keep me continually insured. I was wrong.

When I went to meet with the insurance company representative, she was set up in our lobby. Our lobby is small and people continuously pass through it. There is no privacy and everyone can hear what you are saying if they pay attention. This was where people were supposed to talk about intimate details regarding their health? Really? I’m not sure that was legal; people are probably entitled to a semblance of privacy when discussing personal topics like this.

When I sat down (in the lobby) for my meeting with the insurance rep, she told me that I was not on her list and she would need to call HR and verify that she could put me in the system. She called, then we waited for an answer. And waited. And waited. And made annoying small talk. Finally, she received a text that said, “Stacey Goldstein is not eligible for insurance.” The rep read me the text. This is how I was kicked off my company’s health insurance policy. In the lobby, by text, via someone who did not even work for my employer. Shouldn’t my company’s HR department have informed me of this themselves and in a private setting?

Yes, the company had every right to take me off their policy. I was not meeting the guidelines they set forth; it was a black and white issue. However, the roundabout, public way I was informed of this fact infuriated me.

12/9/09

While still fuming over the treatment my company gave me, I looked at my options for health insurance. I knew that health insurance costs a lot, but I was still surprised by the premiums.

I decided to look up exactly what the Massachusetts state law says about requiring affordable health insurance. I found:

The Massachusetts Mandated Health Insurance Law

“St. 2006, c.58. An Act Providing Access to Affordable, Quality, Accountable Health Care. Added MGL c.111M and amended many other sections. Key provisions of the law include subsidized health insurance for residents earning less than 300% of the Federal Poverty Level, and low-cost insurance for all other residents who are not eligible for insurance through their employers.”

I am no longer eligible for insurance through my employer and I earn less than 300% of the Federal Poverty Level. This information fits me.

12/11/09

I looked further into what health care may be available to me through the state. I decided to apply for a subsidized health insurance program, Commonwealth Care. The income guidelines confirm that I may be eligible. This made me sad, but these programs are there for a reason. I make so little money that paying completely out-of-pocket for health insurance may be my breaking point.

I started to download forms and figure out the application process.

12/16/09

I’m done with my application and it is ready to send in. However, nowhere on the forms or on the state’s website does it state how long it takes to get an answer on approval. To try to find out, I called and asked.

The first person I spoke with told me that getting approved for January shouldn’t be a problem, as long as my application was received by the 25th of the month. The operator said that every application received has to be processed by the 25th. To make sure my application gets there in time, the operator recommended that I drop off my application in person. He gave me the address of where I need to go.

I asked what hours the drop-off center has and the operator said he did not know, I will have to call them. So, I do. The operator at the drop-off center tells me that if I am a first-time applicant, I can’t drop off my application in person. Hmm. I am confused by this conflicting information. I decided to mail in my application, rather than drive half an hour to an office that may turn me away.

12/28/09

It is past the 25th, so I called the state to check on my application. An operator who obviously hates his job and his life answered my call. He had the vocal intonation of someone who has no interest in helping anyone. I am guessing that at some point, maybe he did want to help callers, but now has been beaten down by his job and has become bitter. This man told me that it takes 25 business days to process an application and I am not even in the system yet. I explained that someone else I spoke with told me that all applications have to be processed by the 25th of every month. He repeated that it takes 25 business days. I asked what happens if I get approved in very early January, as I am wondering if I will then be covered for the remainder of the month. He repeated that it takes 25 business days and if approved, I will become covered on the 1st of the following month. This guy was really stuck on this 25 business day thing. Information which, again, conflicts with what I was previously told.

As it feels hopeless that I will receive an answer in time, I decided to purchase a health plan for January. After selecting a plan, I found out that it is too late in December to buy coverage for January. I tried to call one of the health plan companies directly to see if maybe I can get coverage if I talked to an actual person. Guess what, you can’t speak to a person at the health insurance company unless you are already a member. It appears that I will be uninsured for January. This is not good.

This was a big decision; one I thought long and hard about. Psychotherapy has always been helpful, but I simply didn’t want to go anymore. My sessions had ceased covering tragic life events, occupational crises, my childhood, and my parents. Therapy had become a place where I discussed everyday trivialities. These trivialities were still important topics in my life – how to make more money, where to take my career, and how to best deal with relationships – but they did not seem worthy of going to a therapist to discuss. In my session yesterday, I talked about how glad I was that I had mopped my kitchen floor. Seriously? I had so little to talk about in therapy that I was starting to discuss household chores? It was time to move on.

I had been seeing my therapist for a little more than a year. When I started going, my life was filled with uncertainty. I had been laid off for six months and was starting a job I was not sure I wanted. I also was going through a difficult breakup. In the beginning, my sessions were extremely hard. I felt like I had to make the best of my new job. My therapist thought I was in the wrong career. We would argue endlessly about it. I would vehemently exclaim that work didn’t matter, I just needed money. He would retort that if I had work that I enjoyed, the other pieces of my life would come together more easily and that I would place less importance on my continually failing romances. This argument continued until I got laid off from my new job as well and I was relieved of the effort of making my “new” job work.

At that point, our discussions shifted slightly. I was stuck to the idea of finding a job that was similar to my old ones. I was in a field that I did not particularly like, but the money was pretty good and I was used to the environment. I knew what to expect from my old line of work and I found that comforting. Even though I had been laid off twice in less than a year, the types of jobs I had previously held represented security for me. In my mind there were two types of jobs. Jobs where I would have financial security and jobs that I would enjoy. I wanted the financial security. This opinion fueled disagreement after disagreement with my therapist. He believed that if I kept working at the same types of jobs I had held before, I would continually be dissatisfied and get laid off again and again. He thought that the cycle I was in would endlessly continue until I found work I was passionate about.

As I searched for jobs, our disagreements continued. My therapist kept encouraging me to try a different career path. To think about graduate school. To consider working at non-profits. He guided me to think about the things that I enjoyed doing outside of work and how to make a career out of them. I did not listen to him and kept looking for the same kinds of jobs. My therapist often spoke of short-term financial sacrifice for long-term gain. I was not into this idea. Searching for meaningful work while living with 12 roommates and eating ramen noodles was not at all appealing to me.

If I had found a job easily, things may have turned out differently. As it was, there were very few jobs available in my field. Even if I wanted those types of jobs, I could not seem to get one. I was forced to think about other options. Although I was starting to agree with my therapist’s opinion about my work, I was still argumentative about it. During those days, I was difficult to deal with. I doubt that my therapist looked forward to our confrontational sessions.

All these arguments with my therapist eventually took their toll. I was forced to switch directions in my career because my old one did not seem to exist anymore. I had to start fresh on a new path. It was intimidating, but turned out to be for the best. When I tell the story of leaving one career behind and starting a new one, most people perceive it as a story of bravery. Really, I had no choice. And a good therapist.

Once my career issues were on a positive track, I found I had less to talk about than I did before. I still wanted to discuss financial issues with my therapist, but found that we would end up having the same conversation over and over again. He had good ideas, but my continued stubbornness got in the way of some of his suggestions. We sometimes spoke about my dating life, but I had also gotten that area of my life vaguely under control. I rarely had anything hugely dramatic to speak about.

As this shift continued, I began to dread going to therapy. I started to view it as just another task I had to do. I did not feel like I was getting a lot out of my sessions anymore. As my life is full of tasks that I have to do, I decided to cut back my sessions to every other week.

At this point, I also ran into a problem with my health insurance. I had a new insurance plan and provider that considered my therapist to be ‘out of network.’ The insurance provider granted me a couple extra months of sessions, but requested that I use that time to look for a new therapist. I had no interest in looking for a new therapist and my current one was nice enough to work out a deal for me so I could keep seeing him. As much as I appreciated this, I still did not look forward to our sessions. I weighed the pros and cons of the situation and decided to stop going.

It was one thing to decide I was not going to therapy anymore. It was another to actually do it. I went to a handful of sessions fully intending to quit, but I kept chickening out. Yesterday was the day I finally psyched myself up to tell my therapist I was not coming anymore. At the end of our session, he got out his appointment book and asked me when I wanted to come again. I asked if I could call him if I wanted to come. He said yes, but told me he wished I had brought this up earlier. I’m guessing that he knew I had not brought it up earlier because I did not want to be talked out of my decision.

It feels a little strange knowing that I will no longer see my therapist. Therapy was an extraordinary experience that brought me to a more peaceful existence, but I am ready to move on.