“Is Couples Therapy Right for Us?”

What It Is, What It Isn’t, and Why It’s Not Just for Couples in Crisis

When most people hear “couples therapy,” they imagine a couple on the verge of breaking up, sitting tensely on a couch, trading accusations while a therapist plays referee. But that image is outdated. In reality, couples therapy is less about fixing what’s broken and more about learning to better connect, communicate, and grow together.

Whether you’re dating, married, newlyweds, or decades deep into your partnership, couples therapy can offer a safe space to strengthen your relationship.

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💡 What Is Couples Therapy?

Couples therapy is a type of psychotherapy designed to help romantic partners:

• Improve communication
• Navigate conflict in healthier ways
• Rebuild intimacy and trust
• Work through life transitions (like becoming parents, moving, or retirement)
• Heal after a betrayal or long-standing hurt

As a trained couple’s therapist I help both partners understand each other more deeply—often translating what’s underneath the arguments. Think of it as relationship coaching, emotional tuning, and joint self-discovery, all in one.

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❌ What It’s Not

• It’s not about blame. Good couples therapy avoids choosing sides. Instead, it focuses on patterns, dynamics, and underlying emotional needs.
• It’s not a last resort. In fact, going before you hit a crisis can actually prevent one.
• It’s not just “talking about feelings.” Effective therapy gives you tools—like communication skills, emotional regulation, and real-time practice—to create real change.

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🚦Signs You Might Benefit from Couples Therapy

You don’t need to be on the brink of a breakup to benefit. Here are some common reasons couples seek help:

• You keep having the same fight over and over.
• Conversations often turn into arguments or shutdowns.
• You feel more like roommates than partners.
• You’re struggling with parenting differences or blended family stress.
• Trust has been broken and you’re trying to heal or rebuild.
• You want to work on intimacy, emotional connection, or sex.
• You’re just not feeling heard or seen.

Even happy couples go to therapy. It’s a sign of commitment—not failure.

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🔧 What Happens in a Session?

Depending on the therapist’s style (and your goals), sessions might include:

• Joint conversations guided by me, the therapist
• Individual check-ins (sometimes)
• Identifying triggers and old patterns
• Practicing new communication strategies
• Homework (don’t worry—it’s usually just something like “try this small change at home, or think about why this is important and bring that to next session to talk more about”)

I use evidence-based approaches called Emotionally Focused Therapy (EFT), and Couple’s Institute’s Developmental Model.

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💰 What About Cost & Insurance?

Couples therapy is often not covered by insurance because it’s not considered “medically necessary” (no mental health diagnosis is required). That’s the main reason many couples pay out-of-pocket.

However, I will provide superbills for partial reimbursement if one partner is diagnosed with a mental health condition that’s being treated within the relationship context.

Most people think that using their insurance is an advantage when it comes to utilizing therapy. However, there are draw backs to using insurance that you should be aware of when choosing a therapist. Using insurance can have several disadvantages, depending on your priorities. Here are the main reasons why some people prefer to pay out-of-pocket:

1. Privacy & Confidentiality

• No mental health diagnosis required: Insurance typically requires a diagnosis to cover therapy, which becomes part of your permanent medical record.
  • Higher premiums or denial: Insurance companies (including life and disability insurance may see a mental health diagnosis as a risk factor, leading to increased rates or denial of coverage.
  • Long-term impact: These records can follow you even if you’re no longer in treatment or have recovered.
• Greater privacy: Cash payments mean no data is shared with insurance companies, employers, or databases.
  • Highly personal information: Therapy notes, diagnoses, and treatment history can be very sensitive and are often asked for by insurance companies to deny coverage. Therapist notes requests cannot be denied by therapists that are paneled with an insurance company, but an out of network therapist can deny note requests.
  • Potential for misuse: Even with privacy laws, there’s a risk this data could be accessed or shared in ways that harm you, the patient (e.g., data breaches or inter-company sharing).
  • Fear of being labeled: Many people avoid therapy because they don’t want a diagnosis on record.
  • Undermines treatment: Clients may hold back in sessions if they know their info could be reviewed by insurers.
  • Pathologizing normal experiences: To get insurance coverage, therapists often must diagnose even when it’s not clinically necessary, which can over-medicalize temporary or situational issues.
  • Delays and restrictions: Insurance companies may delay approval or limit the number/type of sessions based on records or diagnosis severity. They may request a therapist’s notes in order to do this.

2. More Freedom in Choosing a Therapist

• No network restrictions: You can choose any therapist, not just those in your insurance network.
• Access to specialists: Some of the most experienced or in-demand therapists don’t accept insurance.

3. More Flexibility in Treatment

• No session limits: Insurance often limits the number of sessions or requires regular approval for continuation.
• Custom treatment: Without insurance constraints, therapy can be tailored fully to your pace and goals.

4. Avoiding Insurance Hassles

• No paperwork or denials: No forms, no claims to file, no waiting for reimbursement or risk of denial.
• Predictable costs: You pay the therapist directly—no surprise bills.

5. Therapists Prefer It Too

• More time for clients: Less time spent on admin means more focus on your care.

6. The option of the superbill

• If you decide you still want to use insurance. Can provide you a superbill to submit to your insurance.
• How it works
  • You attend your therapy session and pay the session fee out-of-pocket.

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📄 The Therapist Gives You a Superbill

• A superbill is a detailed receipt that includes:
  • Your name and info
  • The therapist’s info (license, NPI number, etc.)
  • Diagnosis code (required by insurance)
  • Procedure code (like CPT code for therapy)
  • Date and cost of each session
• You can ask for it after every session or monthly—whatever you prefer.

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📤 You Submit the Superbill to Your Insurance

• Log in to your insurance’s member portal or fill out a claim form.
• Upload or mail the superbill along with the form.

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💰 Insurance Processes the Claim

• If you’ve met your out-of-network deductible, your insurance may reimburse a percentage of the session cost (usually 40–80%).
• They’ll mail you a check or direct deposit the reimbursement.

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🔍 Important Notes:

• You’ll need a diagnosis on the superbill—this is required for insurance to consider the claim.
• Not all plans cover out-of-network therapy, so check your benefits first.
• Processing time can vary—some insurers take a few weeks.

Why choose a superbill process instead of insurance

• The biggest win: reimbursement.
  • If you have out-of-network benefits, your insurance may refund 40–80% of what you paid—saving you hundreds or even thousands over time.
• The second win: Privacy
  • Other than the information provided above, a therapist is not required to submit any more information or provide notes to the insurance company unless compelled by a judge when there is some sort of litigation happening.
  • Unlike in-network therapy, where your full treatment info may be shared with insurance, a superbill typically only includes:
    • A diagnosis
    • The dates and types of services
  • You’re not sharing full therapy notes, which helps maintain more privacy.
• The third win: Freedom
  • You Can Choose the Therapist You Actually Want
    • You’re not limited to in-network providers, who may have long waitlists or not be a good fit.
    • You can pick someone who specializes in exactly what you need—trauma, ADHD, LGBTQ+ care, etc.
    • You can often find a better qualified therapist with openings and begin treatment sooner.
    • You control how often you submit claims.
    • You decide how much info to share.
    • You don’t have to wait for insurance pre-approvals to start therapy.

For more information call Debra Schmitt Therapy at (559) 697-5045