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Intense Relationship? Consider a Relationship Intensive

Updated: Apr 11

In the current economy, young people are struggling to live independently and often must continue living with parents, roommates, or partners in order to make ends meet. Wages for the middle class has been largely stagnant for decades, failing to keep pace with the cost of housing, transportation, and child care. Within this financial struggle, a new picture has emerged in the mental health field: trying to work on relationships that might otherwise end, if not for the financial dependency of the relationship.

The members of these relationships can rarely afford to part ways unless they have local resources - friends or family they can move in with. They may not be married and so aren't afforded the protections of divorce court in dividing their assets fairly. The financial strain on the household exacerbates the conflict, as each works to advocate for their individual needs - which must be carefully and empathetically navigated amidst deepening limits on how much the American dollar can accomplish.

Psychotherapy can be an expensive service without insurance coverage, and this has been the case for quite a long time. Within the space of my career, the number of insurance policies covering psychotherapy has exploded exponentially due to legislative changes that have affected the health insurance industry. Overall this has been a net positive for the mental health of Americans who have been in need of psychotherapy. Conjoint psychotherapy - whether between intimate partners who are dating and cohabitating, between friends who have chosen to share living space, or between coparents who must remain in contact in the interest of shared children - has been increasing in need as people seek to maintain rather than end their relationships. However, when utilizing health insurance to cover the cost of psychotherapy, there is a somewhat confusing and potentially controversial standard that can make filling this need much more difficult, known in the industry as "Medical Necessity". Health insurance companies have made it abundantly clear that psychotherapy is only covered when it is medically necessary.

Colloquially, medical necessity means that the service being provided must be a necessary service to treat the diagnosed condition of the insured individual. What this means for relationship therapy often translates to an over-simplified truth: that this service is not covered by health insurance. Many therapists who do relationship work have taken this approach.

However, when relationship problems stem from a diagnosable mental health disorder, such as depression or anxiety, that adds to relationship strain, can create unhealthy relationship dynamics, or makes resolving conflict more difficult, relationship therapy can meed the standard. Arguably, if the mental health disorder is treated, the relationship problem becomes resolvable in some manner that will no longer require treatment. When this is the case, a psychotherapist can bill health insurance for providing conjoint psychotherapy and work with both members of the relationship in ways that treats the mental health condition and improves the overall condition of the relationship as well.

Unfortunately, this is not the most common reason that relationships present for psychotherapy. A great deal of relationship conflict is the result of irreconcilable differences - the more legal term for interpersonal incompatibility. In this case, unfortunately, the health insurance standard of medical necessity is not met and the therapy is not covered.

Until a therapist has met each member of the relationship and has conducted a full assessment - usually a 3-or-more-hour process that can extend across multiple weeks - there is no guarantee that a relationship therapy case will meet the medical necessity criterion. This can mean hundreds of dollars out of pocket before even knowing whether the services will eventually be covered by their insurance.

(Now, let me be clear: divorce attorneys charge more than therapists do, and they usually spend more than one hour a week on a divorcing couple's case - and there are usually two divorce attorneys involved, doubling the cost hour-for-hour. Psychotherapy is generally less expensive than divorce, even when it is not covered by insurance. Working out specific conflicts in a psychotherapeutic setting - rather than a litigious setting - can reduce the expense of a divorce, even if the divorce is inevitable. But this is beside the point, since - as mentioned above - many people who request relationship therapy are not married and need not undergo the divorce process.)

To address the lack of medical necessity in relationship therapy, Equip Counseling has begun offering Relationship Intensives. These Intensives are designed to offer therapeutic relationship work in a way that can quickly address the underlying drivers of relationship conflict when it is unlikely that the medical necessity requirement for health insurance coverage will be met. A Relationship Intensive is two four-hour in-person sessions designed to first assess the relationship thoroughly, then to provide individualized relationship education and guided skills training. The condensed format of these Intensives is designed to get straight to the heart of the problems driving the relationship conflict and attune the partners to the specific skills and intentions that will be needed to reach a resolution. There is an up-front, out-of-pocket cost to the Relationship Intensive that is overall lower than what uncovered psychotherapy would cost across the space of 6 months, and lower than the retainer for a single divorce attorney. Combined with a more immediate impact on the function of the relationship than would be experienced with weekly 45-minute therapy sessions, this makes the Relationship Intensive a cost-effective and results-effective solution for many relationships seeking an alternative to divorce or separation.

If you think the Relationship Intensive is right for you, please feel free to contact us today for scheduling, location, and reservation details. For a free consultation to see if you might already meet the standard for Medical Necessity for conjoint psychotherapy, please email

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