Everyone tells you marriage will be hard — but not this hard. Marriage is work. And it’s harder than anyone ever imagines or thinks it will be.
Marriage is not for soft-commitment types. It isn’t for those who can’t stay through the tough, messy times. Because there will be many times when you’ll say things like, “I can’t take this anymore,” “I’m done,” “I don’t need this,” and so on.
Why? Simple: people have strong, strange emotions when they are interdependent with another person.
Most people are pretty normal and rational in the majority of their relationships, but put a spouse or partner in the room and all bets are off for a person to be their normal self.
This is true even in good times. But when their marriage is in trouble, people start to have even more bizarre thoughts about their spouse. Thinking they don’t care about you, don’t understand you, or outright don’t listen to you. The same person you proclaimed passionate love to months earlier now seems out to get you.
Now imagine how hard it is for the marriage counselor.
I have to love both of you — even when you’re being jerks to each other. I have to be fair and hear each side. I have to make sense of your custom-made craziness. I have to hold hope for you even when I’m the last one standing with any hope.
Sometimes I get a front row seat in a war zone. There are times when I can barely tolerate a couple’s craziness once per week, and I imagine what it must be like to be six years old and marinating in this discord every single day. Imagine being a child growing up in mom and dad’s personalized combat zone.
This is a long way to say that marriage counseling is often absolutely exhausting for the therapist. It is more difficult to deal with two people’s long-standing patterns than to work with an individual client.
With marriage counseling, I have two people working against each other, usually in the worst of times, saying the types of mean things that only intimate partners say to each other. You are each on guard for facial expressions, intonations, movements, and words. Constantly scanning for “proof” that your spouse is wrong and you are right.
Often I feel like I’m a surgeon separating two Siamese twins at the brainstem. It is intricate, delicate work. Because whatever happens to one impacts the other.
What does this have to do with your insurer?
Most health insurance companies don’t consider marriage to be a health issue. In fact, they don’t think relationships are health problems. This means they don’t reimburse for counseling for any type of relationship problem — even for couples with children.
Now, I think they should pay for marriage counseling. Because I know that intimate relationships are very stressful. And many illnesses are exacerbated — if not outright caused — by stress. So I believe the health insurance companies would probably save themselves money if they were willing to pay for marriage counseling.
But unfortunately, I don’t make the rules. Health insurance companies pay the bill, so they get to define what is medically necessary and what isn’t.
Yet the public seems to believe that marriage counseling is a covered benefit from their health insurance company since it’s a type of psychotherapy. And because of this, marriage counseling and relationship therapy are gray areas that many therapists will “fudge” for.
Nevertheless, it is fraudulent to write “marriage counseling as medically warranted” for reimbursement.
The unique circumstances in which insurance companies will pay for a couple to be in the session together are very limited. Such as when one person (the primary patient) is seeking psychotherapy for their depression or anxiety, and once in a while, their partner comes in to sessions to help their loved one with their anxiety, depression, or another medically necessary diagnosis. Some therapists will write this up as one patient in the room, regardless of how frequently they both attend.
This “once in a while” scenario is vague as defined by insurers. However, in my definition, if we talk about anything other than the primary patient’s depression or anxiety, it is relationship counseling.
In my definition, I’d say this could legitimately be written up for the insurance to pay if their partner came in maybe once every 3-6 months.
So I will not bill insurers for your relationship counseling sessions
Because the public is misinformed about this, and because we live in a country where everyone wants to use their health insurance, many people are surprised to find out that marital therapy is not covered under their policy.
People call my office and say things like:
- “Well, the insurance company said, ‘It depends on how the therapist writes it up.’”
- “I was told Sally would ‘fix’ that for us.”
- “I thought Sally would write it in a way where it would be covered.”
- “You mean she won’t bill it to get reimbursed?”
I know there are other clinicians who do all of the above without a second thought, but I am strict about this. It saddens me that other clinicians won’t stand up about this. Instead they allow themselves to be strong-armed into unethical and downright illegal actions in order to help their clients get insurance to pay for an uncovered expense.
Therapy isn’t cheap. But it is cheaper than divorce. And the investment in your relationship and your wellbeing will bring you far greater value than any home renovation, trip, jewelry, car, or other tangible item.