Frequently Asked Questions
We accept Lyra Health and are currently in the process of credentialing with Aetna, but otherwise are considered out-of-network. What that means is that you would pay for therapy at the time of the session, and seek potential reimbursement from your insurance. We are happy to provide the documentation needed (i.e., a "superbill") to support your efforts for reimbursement. It’s important to look at your benefits if you will be seeking reimbursement. We’ve had clients who receive significant reimbursement and some who have no benefits. You can always use a HSA or FSA card for services. Also, most people have higher deductibles, so unless you have a major surgery planned, you may not hit your deductible. If you have to pay 100% up to your deductible, that means that you’ll pay out of pocket for in-network and out-of-network.
We encourage you to investigate all options regarding insurance and arrive at an informed decision regarding your mental health care. There are many advantages to not using insurance for therapy, including confidentiality, having access to specialists, and more control over your treatment in general.
If your insurance plan includes out of network benefits, the insurance company will likely require you to submit a superbill before they will provide any reimbursement for services. A superbill is essentially a detailed invoice that you can submit to your insurance company so that they can determine what percentage of our fees, if any, they will reimburse to you. Superbills are usually provided on a monthly basis and include all of your therapy services for the month. They also include the dates of your sessions, the reimbursement code for your sessions (which also indicates the length of time of the service), our fees, and what you paid. Of note, clinicians are required to provide and include a diagnosis on your superbill, as insurances require a diagnosis in order to cover services. This diagnosis becomes part of your permanent record with them and must be placed in our electronic medical record. If you do not want to provide a diagnosis to your insurance company, you may not want to submit superbills or seek reimbursement from them.
There are a number of reasons why we have chosen not to work with insurance companies:
- When filing insurance, companies require that clients are given a diagnostic code for billing, even if a diagnosis may not be appropriate. By not billing insurance, we can meet client needs without labeling the mental illness for an outside company.
- Protecting your privacy. By releasing private information to a third party or insurance company, it increases the risk of client information being exposed. Also, if you or your child needs a federal background check for reasons such as joining the military, wanting to be a pilot, or for a number of other reasons, their personal information may be obtained through insurance. We want to offer the highest protection of your private mental health information.
- Given the highly-specialized services we provide, it is critical that you and the therapist determine all aspects of your treatment, rather than allowing insurance companies to dictate your treatment. For example, some insurance plans choose the length of treatment, number of sessions, or duration of sessions. Believe it or not, many insurance companies have even sent letters to therapists discouraging them from seeing clients for a full hour. By not filing insurance, your therapist can offer the most effective treatment as opposed to allowing insurance to determine treatment options.
- Time. Working with insurance requires countless hours back-and-forth on the phone, email, etc. - precious time that we would rather use serving clients who need our services.
Although you are paying a premium for a highly-specialized treatment, research indicates that DBT is cost-effective and actually saves money in the long run. One study by the American Psychiatric Association demonstrated that DBT decreased mental health treatment costs for clients by more than $20,000 (56%), particularly due to decreased ER visits, hospitalizations, and partial hospitalizations. Overall, research demonstrates that although DBT is a significant financial investment, clients who participate in DBT ultimately spend less than they would if they participated in a non-DBT therapy, particularly given that non-DBT therapy would likely last longer and would not prevent the high cost of hospitalizations. You can learn more about the cost-effectiveness of DBT here: https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/
DBT, or Dialectical Behavior Therapy, is an evidence-based treatment developed by Marsha Linehan, Ph.D. DBT is the gold-standard treatment for individuals who experience chronic emotion dysregulation or who are chronically suicidal. Originally published as a treatment for borderline personality disorder (BPD), DBT has since proven effective in treating multiple disorders, including mood, depression, alcohol and drug use, and eating disorders.
DBT is based on Marsha Linehan’s biosocial theory, which states that chronic emotion dysregulation stems from a transaction between emotional vulnerability and an environment that invalidates or trivializes the person’s experience. DBT is designed to help teach clients how to reduce emotional vulnerability and learn to interact effectively with the environment.
A core piece of DBT is the skills training group. This is typically a 6-12-month commitment during which clients learn skills to help them be present in the moment, regulate their emotions, tolerate distress, and interact effectively with others. Clients are expected to attend a weekly group and apply the skills they learn in their lives. In this respect, the saying “It works if you work it” is very true for DBT - if you want to do something different, you gotta do something different.
Additional pieces of DBT include structured individual DBT therapy, skills phone coaching, and a consultation team for the therapist. Although many people benefit from all four modes of DBT, it is important to discuss this with your therapist and determine what modes of treatment will help you best meet your goals.
The highest standard in assessment of DBT delivery is the DBT-Linehan Board of Certification™ (DBT-LBC). DBT-LBC is the only DBT certification endorsed by Dr. Marsha Linehan, the treatment developer. Clinicians who are certified by DBT-LBC have passed rigorous assessment of their DBT knowledge and skill and have been deemed to provide DBT adherently. Currently, there are only approximately 350 DBT-LBC certified clinicians globally.
To confirm certification of your DBT provider or program by the DBT-Linehan Board of Certification™, please visit the DBT-LBC website, https://dbt-lbc.org then click consumers, and then click “Find a Certified Clinician” or “Find a Certified Program.”
The Founder & CEO of Cincinnati Center for DBT, Dr. Nikki Winchester, is a DBT-Linehan Board of Certification, Certified Clinician™, and oversees the work of all DBT clinicians at Cincinnati Center for DBT. All of our DBT therapists participate in extensive DBT training and are in the process of meeting the requirements for certification through the DBT-Linehan Board of Certification™ (DBT-LBC).
DBT is a six-month commitment because it takes six months to get through the DBT skills curriculum. You will learn the mindfulness skills several times throughout your group commitment because these are the core skills needed to effectively use the other DBT skills! We also spend 6-8 weeks in each of the distress tolerance, emotion regulation, and interpersonal effectiveness modules.
This is something best discussed with your individual therapist. Your therapist will discuss your goals, targets, and what’s bringing you to therapy and collaborate with you to decide the best plan for you. Although everyone could benefit from learning DBT skills, some clients will benefit most from engaging in comprehensive DBT, which includes individual DBT therapy and phone coaching, in addition to the DBT skills group. Clients who are good candidates for comprehensive DBT are those who: self-harm or have frequent urges to engage in self-harm or suicide attempts; experience problems with substance use or addiction; have an eating disorder; have been diagnosed with borderline personality disorder (BPD); have difficulty staying in mental health treatment; experience significant impulsivity and problems in relationships; find that their symptoms interfere with their ability to have a reasonable quality of life (e.g., maintain a job, housing, financial stability, or relationships).
Anyone who participates in a DBT skills training group is required to engage in individual therapy at least every other week to support them while they are in group. However, not everyone requires comprehensive DBT. Your therapist will be happy to discuss your treatment needs with you.
DBT was originally designed as a one-year treatment, during which clients went through the full six-month commitment of skills two times. However, research has shown that not all clients need two go through the skills twice. As of this writing, research has not determined who exactly needs a full year of skills versus six months. We encourage you to discuss your progress, goals, and options with your individual therapist and skills trainers when considering graduating or recommitting to DBT skills group. Our clinicians will review your clinical outcome data with you and discuss your progress so that you can make an informed decision about how long you want to be in DBT.
- DBT skills training is more like a class than a psychotherapy group. In the past, you may have participated in a psychotherapy group or seen psychotherapy or support groups in TV shows or movies. Oftentimes, when people think of group therapy, they think of a bunch of people sitting around sharing intimate details about themselves and crying a bunch. That is NOT skills training! DBT skills training is structured like a class where your skills trainers teach you skills, help you practice skills, and review how you practiced skills between classes. The format is highly structured and there isn’t much room for discussion outside of learning and practicing skills. We’ve had many clients feel apprehensive about starting DBT skills training due to preconceived notions about group therapy, but once they started group and experienced the structure of it, they were glad they joined.
- DBT skills groups allow for exponentially more learning than when skills are delivered one-on-one. In DBT class, you get to hear how others are applying the skills and you get to learn from the feedback the skills trainers provide to the other group members. Oftentimes, another group member may apply a skill in a situation similar to what you’re going through, when you didn’t even realize that skill could be helpful in your situation. Other group members may ask questions, make comments, or share examples that further your understanding of the skill.
- You will learn that you’re not alone. When people are suffering, they often think that they are alone in their pain and that others couldn’t understand it. They might feel afraid of or uncomfortable sharing their emotional pain, concerned that people will judge them. Sometimes they’ve even had the experience of others invalidating, judging, or making fun of them for how they feel. Clients who participate in DBT skills group learn that they are not alone and learn that group is a safe place to take off the mask and practice using skills to solve problems. Although not everyone in group is dealing with the same problems or diagnoses, everyone in group is there to learn how to manage their emotions and relationships better.
- DBT skills group is cost-effective. When you participate in group therapy, you are sharing the cost of the session with other group members, instead of paying for the entire session yourself. That means you pay less per session and have longer skills sessions when participating in group compared to learning the skills in one-on-one therapy. For example, our adult skills training groups cost $90 per two-hour session with two facilitators, vs. our individual therapy sessions cost $160-$200 per 45-60-minute session with one therapist.
When developing DBT, Dr. Marsha Linehan found that it was extremely difficult to try to address a client’s individual problems and goals AND teach them new skills in a single session. When she tried, she found that either the individual problems or the skills did not get the amount of time or attention needed. That’s why she decided it was more effective for clients to attend one individual DBT session and one DBT skills training group per week. In skills training group, clients attend a class focused on learning needed coping skills. In individual sessions, the client and therapist focus on the client's individualized goals and targets; the therapist helps the client use the skills they learn in group in their specific situations.
DBT Graduates Group is designed for clients who have completed one year of DBT skills training and who would like help strengthening their DBT skills and generalizing their use of DBT skills to more contexts in their environment. Clients who have completed one, six-month round of DBT skills training are considered on a case-by-case basis. To be eligible for DBT graduates group, clients must have a strong understanding of the DBT skills to the point that they would not need to learn the DBT skills again.
DBT Graduates Group puts more emphasis on the group members holding themselves accountable to strengthening their DBT skills. Usually, there is not much teaching of the DBT skills and there is no homework review. Instead, DBT graduates group members use the time to discuss their struggles and successes with the DBT skills. DBT graduates group members will help each other problem-solve how to overcome obstacles with using the DBT skills. Additionally, DBT graduates group members will take turns leading the mindfulness practice at the beginning of group in order to strengthen their mindfulness practice and understanding.
Many of our DBT graduates group members have shared that they appreciate the accountability the group provides, as it can be hard to continue to remember and practice DBT skills when not attending a weekly DBT group. DBT graduates group is only one-hour long and group members are asked to commit one module at a time (e.g., mindfulness + emotion regulation, interpersonal effectiveness, or distress tolerance), although most group members participate in at least one full round of DBT graduates group. If you are interested in registering, you can contact us at 513-494-6698 or firstname.lastname@example.org.
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