I have excellent medical insurance and not-so-excellent mental health care insurance. For years, E. was in their preferred provider network, but she finally left them because they micromanaged treatment and reimbursed substantially below market rates. She left their network about two or three years ago. Now that she’s out-of-network, they don’t bother her much, and my co-pay increased from $10/session to $65/session. It’s a lot, but there’s no way I was going to go therapist hunting after years of working with her.

Suddenly, last week they called her to check in on me. I had triggered one of their alarms by having more than x number of sessions in the last three months, or something like that. They left her a message saying they wanted to know my diagnosis, my treatment plan, and what progress I was making. She told me this when I saw her last week, right before my surgery, and she said she’d talk to them. I felt a sudden fear that they we say I’d had far more than my fair share of therapy and would need to taper off. Or worse yet, go cold turkey.

In my session today, I ask what happened with the insurance. She says she talked to them yesterday for about 20 minutes. She explains they have a standard list of questions they ask. What is going on with her? Depression, E. tells them. (She always tries to give the minimal, least dramatic diagnosis she can and says the rest is not really their business and doesn’t need to be in my file.) How I am doing? Making great progress, E. assures them. Has she tried medication? (Ironically, they have no connection whatsoever to my psychiatric nurse, so they don’t know that I have been taking medication for years. With questionable results, I might add. Perhaps they should be sticking their nose into that side of things.) E. tells them I am on medication. Has she tried EMDR? No, but she has just started working with someone who might provide that for her.

Okay, fine, I can live with some insurance administrator writing all this down. It’s needless but whatever. The questions I care about are 1) are they going to check back in after 10 weeks or 20 sessions or something? and 2) do they want me to wrap it up within a given number of sessions?

No, E. tells me. “As long as you are making progress, they are okay. And since I am not in network, they don’t monitor my every move. They may not call again this year, for all I know.”

I know I look skeptical. I wait. She’s not the only one in the room who can use the pregnant pause to good effect.

“Okay,” she relents. “You know what is your ace in the hole? It’s the burning yourself. They are never going to cut you off when they hear about that. They want you in therapy.”

A piece of me laughs, on the inside. As long as I don’t give up the self-harm, they’ll never make me stop seeing her. Well, that makes it easy, doesn’t it? And what kind of backwards motivation is that for moving beyond the self-harm?

At the same time, I know E. could tell me this because she knows that as much as I value my time with her, I really do want to get better. One day, probably not in the immediate future, I will stop harming myself because I will stop feeling the need to do so. And someday further out in the future, I will start to reduce my visits to E. because I will feel confident that I can handle my mental health and continue to grow and develop without the intense needs I still have now. I actually believe this now. I didn’t use to believe that I could get better, but now I do, even though I have no idea whatsoever how long it will take.

(Until I reach that point though, I’ll keep an ace up my sleeve.)