What is better, private practice counseling or hospital outpatient counseling? Expectations uncovered.

Navigating the counseling world can be really confusing. It seems like there are different ways of getting counseling but one often feels unsure which option is the best. You want to see results as effectively and quickly as possible so picking the right therapist for the job is really important. As a parent, you don’t want to give anything less than the very best for your kid which is probably why a lot of time goes into researching the right therapist. I wanted to spend a little time informing current clients or even potential clients on what to expect when it comes to choosing a private practice provider versus a hospital outpatient setting provider that usually comes with one’s insurance plan. Being someone who is currently working in both private practice and at a hospital outpatient setting, I think it would be beneficial to know what to expect! The truth is there is no perfect system which is why there are benefits and costs to both. I will also mention a little bit about county services though my information is anecdotal and not from personal experience.

The biggest and most obvious factor is financial costs. Private practice counseling is generally more expensive per session and only some of them work with insurances (e.g., Aetna, Blue Shield, United Health Care, etc.). Some of the reasons for the higher cost is similar to any kind of small business. There are general costs of renting space, paying for the amenities, marketing, and covering self-employment costs such as the provider’s own health insurance, malpractice insurance, and retirement. Outpatient settings that are embedded in hospitals and other clinics generally have the clients pay a co-pay which are normally cheaper and sometimes even free for really good insurances. The hospital or clinic have more financial resources from the thousands of members who pay into a pot of money which cover the cost to “set-up shop” for the therapist. 

The real question comes down to value and what you are looking for in counseling. The analogy is that private practices are more like specialty boutiques while hospital settings are more like large department stores. Aspecialty boutique is a store that has more unique products (sometimes from local vendors) that have been handpicked by the store owner. A large department store (think Nordstrom, TJ Maxx, etc.) is like a franchise that has a mass-produced formula of products selected by the corporation being managed by the employee.) Private practice counseling generally has the option of more frequent sessions and availability because the inflow and outflow of the caseload is fully controlled by the private practice therapist. There is more customization to meet the needs of the client and a certain level of accessibility to the therapist through emails, phone calls, and texts if there are some requests that need attention more immediately. The outpatient hospital setting has certain productivity demands that are beyond the control of the therapists such as how many new clients are added to the caseload every week and preset hours of operation. In my experience, hospital outpatient providers see a larger caseload of people so the availability for more frequent sessions becomes much more limited. For example, a typical return appointment at Kaiser Permanente can range from 3 to 6 weeks compared to private practice’s range of 2x a week to every other week. There are exceptions to these frequency expectations for therapists at hospital outpatient settings to see a client a little more frequently due to the severity of the issue. Due to the huge uncontrollable caseloads for hospital outpatient settings, the therapists can literally only do that for a select few so it sometimes comes down to luck as to whether you or your child can be seen as frequently as needed for optimal care. The benefit of being seen at an outpatient hospital setting is the collaboration with other services that are readily assessable such as medications from psychiatrist, testing referrals for diagnostic clarification (in rare cases), inpatient hospitalizations, other treatment programs, and other medical appointments as needed. Please read my other articles on inpatient treatment, partial hospitalization programs, and group therapy for more information.

Does the frequency of appointment visits matter to treatment? The general answer is yes. Being seen weekly has the significant advantage of building rapport and trust much more quickly which is the bedrock of the counseling relationship. It also takes advantage of making important changes with professional guidance while the client is motivated and ready to do the hard work. Clients who tend to see the value of counseling and are willing to pay the cost for treatment tend to see the changes more effectively. This is not always the case for clients who are ambivalent to change or lack the opportunity to be seen the adequate amount of times because the lack of guidance and support is not there during the difficult times. Clients who have fewer pressing issues and less acuity can still benefit in big ways through monthly counseling so it really depends on your circumstances.

If you happen to qualify and have County Services such as Medi-care benefits, then you may experience both extremes in terms of services. I have colleagues who work for the county that are able to see their clients multiple times a week, get case management to keep all of the services in order, and even do things like home visitations. The reality is that some of these county therapists only have five or six clients to take care of on their caseload at a time. That means if you are not one of the lucky ones on their caseload, then you are put on a wait list which could last several months to a year before adequate services are available.

To sum up the services, private practice often provides the highest quality of individual care and access for a higher financial price which is more appropriate for clients with less high risk issues (such as suicidal intentions, homicidal intentions, grave disability, etc.). The hospital outpatient settings provide quality care with less individual access but with a greater access to other resources more appropriate for clients with higher severity of symptoms.

If you have any further questions about whether private practice counseling or some other counseling is right for you, please don’t hesitate to call or email me. I can provide additional assistance through a phone consultation to clarify your questions! 

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