"Astoria for grief" and the managed-care swap meet

You can imagine my momentary confusion on spotting this subject line from an unfamiliar email address:

"Astoria for grief."

The title reminded me of one of those 1970's only-in-NYC thrillers, like The Taking of Pelham 123, or The French Connection, or even the Spider-Man series, and I began to envision a hospice-worker protagonist rushing to catch the Queens-bound R train, then dodging behind seats and between subway cars to avert pursuing Russian spies.

In reality, it was work related, simply an innocent referral request, forwarded to me via an email group to which I (reluctantly, at times) subscribe: Therapist A seeks Therapist B, who accepts Insurance Plan C, in NYC Neighborhood D for Issue E.

The truth is, I get these sorts of emails all the time. Perhaps it was the pithy headline that threw me; generally the longer subject line leaves less open to interpretation.

This email group is intermittently fascinating and infuriating (and, on rare occasions, useful). We get about 10 emails a day, sometimes a bit more or less depending on the season (demand for psychotherapy in NYC is seasonal--we're in a busy season, so traffic's been heavy). They almost always follow the pattern above, sometimes with a few more or less modifiers.

A swap meet (but have we met?)

One thing to keep in mind is that most of these therapist (by my estimate there are 300 or so in this particular group) have never met one another. As a result, they're basically looking for a name they can pass along to a potential patient who's called them, but needs someone who accepts a different insurance plan, or has a more convenient time available in their schedule for that prospective patient.

At best, the inquiring therapist can get back to this prospective patient with the name of an available therapist who meets those very basic criteria. There's no ability to gauge quality, training, style, experience, effectiveness. Not much, anyway. How could there be when the conversation starts with a subject line like, "Astoria for grief?"

Why do they bother?

A few reasons. For one, there's a genuine desire to connect an inquiring patient with a provider who can help said patient (however misguided the swap-meet approach may be in helping someone find a good provider who is a good fit.)

I suspect there's also something more sinister at play, namely the expectation of finding a therapist to whom you can send referrals who will return the favor by sending you referrals in turn, quid pro quo.

Did you know you were being swapped like a mid-century love seat for a pile of old records?

Take yourself off the market

When you take an activity that's as complex, and as deeply personal as psychotherapy and leave it to insurance companies to manage, or attempt to squeeze it into a few narrow categories, it's all too easily lent to distortion and to packaging and repackaging as a commodity, fit for swapping.

In that case, there are meaningful questions that can't possibly be addressed: Wouldn't you be willing to take a longer trip on the subway for a therapist who really works for you? What if you want to see a Muslim therapist? Or someone who incorporates mindfulness? Perhaps you'd like to work with a fellow veteran, or someone who's adopted a child, as you have.

Sure, categories and logistics can be a good place to start, but your search for a therapist deserves more care than managed care will easily make room for. You've got to talk to a lot of people--find out the sort of therapists they work with. Spend some serious time online, reading articles, and browsing the growing number of therapists' websites. If a few therapists look interesting, call them all, and don't be afraid to shop around.

Consider leaving the neighborhood--not just your geographic neighborhood, but also your comfort zone. Shop for a challenge (not just a bargain).

Your superhero just might be a few subway stops further away.