Although I’ve included a piece on my website about intensives versus standard therapy, I wanted to take the time to expand a bit on why I switched to intensives in 2021 and why I have become a strong believer in this therapeutic format.

I started working in addiction and mental health in 2004. First, in an adolescent inpatient and residential treatment program, then later transitioning to work for the courts. I worked for the courts from 2008-2020, developing and implementing programming for juvenile probation, adult probation, and the county jail. I had so many amazing experiences working with this population, but I got trained in EMDR therapy in early 2014 and found that I was not able to utilize EMDR as much in this setting as I would have liked. I joined a group practice, Indy Counseling Professionals, in 2014, just a few months after becoming EMDR trained. This opportunity was a nice adjunct to the clinical work I was doing for the courts.

While practicing in a private setting really enhanced my clinical skills in a different way than the courts, I was now dealing with something new to me: the ins and outs health insurance plans. Navigating insurance billing was more manageable in those days, but I learned very early on that insurance companies dictate far too much of what happens in the therapy room.

ME: “I’m the clinician working with this client and should be able to deliver their therapy in a way that fits their clinical need.” THEM: “We’re paying, so we will have the final say on what is best for the client.”

Also, it became pretty clear to me over time that there is a significant incongruence between therapist skill level and specialization and the contracted insurance reimbursement rates. For behavioral health, insurance does not reimburse based on procedure. The reimbursements are based on how much time you spend with the client. This means that a clinician who is in their first year of clinical licensure and has no specializations is reimbursed the exact same rate as a therapist with 20 plus years of experience who has invested substantial time and money on advanced trainings and consultation. See the problem here? It feels akin to asking an oncologist to accept the same reimbursement as a general practitioner.

For a therapy session, therapists are only reimbursed for 53 minutes. This is considered the “clinical hour”. A session that is 53 minutes or more is typically reimbursed approximately $30 more dollars than a session that is 38-52 minutes (at least in Indiana). As you can imagine, many therapy sessions go over 53 minutes, though insurance would prefer that we bill at 52 minutes and receive less compensation. In fact, this is one of the primary reasons that insurance companies “claw back” money from therapists.

How does this factor into my decision to do intensives, you might be wondering? Historically, the standard length of an EMDR session has been 60-90 minutes, not the 45 minutes that insurance companies would prefer. Over the last several years, I have found that having the client come in for a 3 hour session, 3-6 times, yields accelerated symptom reduction, improvement with mood and anxiety, and has allowed us to complete the EMDR treatment plan (addressing all three prongs of time: past, present, and future), much more efficiently than the standard weekly/biweekly clinical hour sessions.

An intensive format also gives the client and I the freedom to customize an EMDR outpatient program that fits their needs. By scheduling an client’s intensive sessions every 2 weeks until the treatment plan is complete, and including a digital workbook and virtual check ins, the treatment stays focused on the identified plan and is completed much more quickly compared to the standard delivery model. I have also had clients travel to Indianapolis for 1-3 days and complete their intensive during that time. Again, we have the freedom to choose what works best and do not have to acqueisce to the insurance companies.

On another note, I have a partnership with the Indianapolis Metropolitan Police Department that I value greatly. This partnership also means that I need to keep flexibility in my schedule to see an officer quickly who may be in crisis. Switching to an intensive model for my civilian clients has afforded me the flexibility to be able to do this. I am super grateful for that.

If you or someone you know is interested in doing a therapy intensive, please feel free to reach out and schedule a consultation. This format may not be a good fit for everyone and I’m a strong believer that clients should have choices. If I’m not the right fit, or intensives don’t make sense for you, I’m happy to connect you with a trusted colleague.