Restarting Therapy, Again, and Yes I Cried in the First Session

Let's talk about the system, the deductible, and why we should be allowed to submit a PowerPoint to our therapist.

So here's the thing about trying to take care of your mental health when you're a person who has to actually think about money: it's a whole process. And not in a cute, "journey to healing" kind of way. More like a "multi-step bureaucratic nightmare disguised as self-care" kind of way.

It started simple enough. I needed a referral — either to adjust my medication or just get a check-in with someone who could actually sign off on things. Okay, fine. I make the appointment. I show up. I do the thing. And then I get referred out to a third-party provider through Kaiser, because of course I do.

Here's my insurance situation: I have one option through my nonprofit job. One. And it comes with a high deductible. A very high deductible. Like, "this number should not be attached to the word healthcare" high.

So I'm already bracing myself. And then the call comes.

"Hi, your bill for that session is over $100."

Cool. And that's not a one-time thing. That's every session until I hit my $3,000 deductible. Which — and this is the part that really sent me — resets in August. AUGUST. It's not even close to December. I will not meet that deductible. We both know it. The insurance company knows it. The universe knows it.

So let me paint you a picture: I needed therapy. I did the work to get the referral. I finally got the appointment. And now I'm being told that getting mental health support will cost me over a hundred dollars a session out of pocket because of a deductible I will never realistically meet before it resets.

And THAT is what caused the menty b. Before therapy. Because of the process of trying to get therapy.

The irony is not lost on me.

And I want to name something, because I think it matters in the context of who I am and who a lot of you reading this are: this isn't just my individual struggle with a broken system. According to SAMHSA data, two in nine Latinos in the US face mental health challenges — and more than half of them never receive treatment.⁵ More than half. The barriers are a whole list: no insurance, cost, not enough Spanish-speaking providers, stigma, not knowing where to even start. And all of that is before you factor in the bureaucratic loops I just described. So when I say the system isn't built for us, I mean that literally. The data says it too.

And before anyone says "well what about Medi-Cal" — I've been there too. It's not pretty either. There was a point in my life where navigating Medi-Cal for mental health services was actually manageable. I got through it, found a provider, got seen. But years later, when I was trying to help a friend look into it, the whole landscape had shifted. You couldn't just call a provider directly anymore. You had to go through 211 first, get routed to some intermediary organization, and then hopefully end up somewhere useful. The direct line was gone. Another layer added between a person who needs help and the actual help. And the people who most need it — and have the least bandwidth to jump through hoops — are exactly the ones most likely to give up before they ever get seen.

So no, this isn't just a private insurance problem. It's the whole system.

If you haven't seen my instagram crash out video but more so where I'm just cleaning my face from crying/trying to stop crying after the session go do that.

Now, here's the part I really want to talk about — because I think this is a cultural thing, a trauma thing, and honestly just a design flaw in how therapy works:

When you finally sit down in that room (or on that video call), you are expected to just... start talking. About everything. The childhood stuff. The family dynamics. The things you've already cried about a hundred times but somehow have to explain again from the beginning because this is a new provider and they don't have your full file of lived experience.

And it hits different every time. It doesn't matter how many times you've said it out loud — the moment you start recalling certain things, the emotions come right back like they never left. Full body. Instant tears.

I hate it.

And here's the thing — I already know. I know exactly what's going to come up. I know what the triggers are. I know what qualifies as "traumatic" in therapy speak. I know what I have to tell them because in theory, they can't help you if you don't. So I walk in already aware of what's about to happen to me emotionally, and it still happens every time. There's no building up immunity to your own story. You can intellectualize it all you want and you're still going to cry in front of a stranger you just met.

This time, I didn't cry before the session. The crash out came before — the menty b was the insurance call, the bill, the whole situation leading up to it. But the crying? That happened during the session. Right on schedule. I knew it was coming. I could feel it building the second I started talking. And still — still — when it actually happened, it caught me. Not by surprise exactly, more like... I knew the wave was coming and it still knocked me over.

This is not my first time starting over. Every time I've gone back to therapy — regardless of where I left off with the last provider — I cry in the first session. Every single time. I've come to expect it. I even brace for it. But expecting it doesn't make it easier. Crying is exhausting no matter how prepared you think you are. You still leave feeling wrung out, a little raw, and like you need a nap and something sweet.

Which is why I am formally proposing: therapists should accept PowerPoints.

Not joking. A nice little slide deck. Organized sections. Key bullet points. A "here's what we've already covered in previous therapy" slide. A "current triggers" slide. Maybe a timeline. Possibly a pie chart. If I can put together a presentation for a quarterly board meeting, I can absolutely put together one for my mental health provider. And I would. Gladly. It would save us time, help me process before I'm in the room, and mean I don't have to say the hard thing out loud and then watch someone take notes while I'm still actively crying about it.

And all of this — all of it — was just to try and lower my medication dosage for half the month. That's it. That was the ask. A small adjustment. And somehow that required a full therapy session, a referral, a third-party provider, a $100+ bill, and an impromptu emotional unraveling.

Sigh.

Here's the thing though: I did know I needed to go back. I'd felt it for a while. I had actually graduated from therapy not too long ago — which is a real thing, and I was proud of it. My therapist and I had done the work, and at some point she assessed that I had the tools to cope on my own. The insurance company agreed. And according to them, "successfully coping on your own" is the finish line.

But life had other plans. Without getting into names or specifics, certain individuals tied to a previous job situation had me increasing my dosage not long after I graduated. Possibly even while I was still in therapy. And I had all the tools. I really did. I just also had a situation that was actively working against me, and tools only do so much when the environment is relentless.

The thing I've always believed — and that this experience brought back up for me — is that therapy shouldn't have to be a crisis response. A once-a-month maintenance check-in should just be normal. And there's actually research that backs this up: once someone has done the initial intensive work and developed solid coping skills, monthly sessions are considered a totally appropriate and effective maintenance schedule. Not a step backward — a step forward. The kind of preventive care that keeps you from having to start over again every few years.

But once my therapist decided I could cope on my own, the insurance said we were done. Even if there were still things to work through. Even if life was still happening. Apparently the bar is "functional enough to not be covered anymore" — not "supported enough to stay that way."

Coming back to therapy now, I realized how much I had actually needed that one cathartic cry. Not because I don't cry on my own — I do. But therapy is different. It's the space where I let it all the way out. I don't share the big feelings with a lot of people in my life. Not because I don't trust them, but because it's genuinely a lot to put on someone else.

I want my friends around for the good and the bad — I want them to show up, I want to celebrate with them, I want them to lift me up when I'm down. But I don't want every conversation to feel like a session, because eventually that becomes its own problem. Friendship is not therapy, and it's not fair to either person when it starts to feel that way.

And I want to be clear about something: if I tell you I'm open to listening, I mean it. I will not offer that if I'm not actually in the space to hold it. I want you to feel like you have a safe space too, and I will always encourage anyone reading this to find a therapist — because what I can offer is love, and what a therapist can offer is a whole different level of skill and structure.

I'm also really lucky, and I know it, to have my fiancé through all of this. He is genuinely a huge reason I haven't had more menty b moments this whole stretch — and the ones I have had, he's been right there. He is the reasonable brain in this household. Mine can be reasonable too, but sometimes it likes to take a detour, and he knows exactly how to help me find my way back to the ground. He makes me laugh when I'm spiraling. He reminds me not to take things so seriously when I need to hear it. More than he probably knows, he's kept me stable.

Now back to the money part. Because we have to go back to the money part.

As much as I genuinely love my job — and I do. I have a supervisor who trusts my decisions and my perspective, especially when it comes to fundraising. I have real autonomy. I am not micromanaged, and I cannot overstate how much that matters to me because it has not always been the case. I love the work. I love the mission. I love the people.

But nonprofit life has a double-edged sword, and it is the pay. And I say that understanding it's a structural, organizational challenge, not a personal one. It's the reality of the sector. The hard part of loving your work is that loving it doesn't cover your bills.

So now I'm navigating: the $3,000 deductible I won't meet before August. The car payment. High insurance rates because I'm a newer driver. Half of rent. Wanting to actually be able to help a friend when they need something. All of it adding up while I'm also trying to take care of my mental health — which, again, costs over a hundred dollars a session.

I had to ask my therapist to move to biweekly sessions. I don't know for how long. That's something we need to talk through at my next appointment. I love her and want to keep working with her, but I also have to be honest about what's realistic right now. And right now, weekly sessions at $100+ a session is not it. I may need to pause entirely until something changes — a new job, a change in coverage, something. I don't know yet.

What I do know is that I shouldn't have to choose between mental health care and my car payment. But here we are.

After that first session — after all the crying and the recapping of things I didn't want to recap, and the crash out that happened before I even got there — you know what we did?

We got a McDonald's ice cream cone. Hopped in the car we have to pay for — a small nod to a Metric song, iykyk — and went and got something sweet and cheap and good. Because sometimes that's the move. Sometimes you cry everything out and then you go get a soft serve for a dollar and you sit with it and you breathe.

And honestly? It helped.

Here's what I want you to take from all of this, if anything:

Crying in therapy is normal. Crashing out on the first session back is normal — it happens to me every time, and I know going in that it will. It doesn't get less exhausting, but it does get less scary once you accept that it's just part of the process.

Monthly maintenance therapy is a real and valid thing. You don't have to be in crisis to deserve support. You don't have to justify needing a check-in. The idea that you "graduate" and then you're done is a framework built around what insurance will cover, not what actually sustains people.

And if you're working through something and money is the barrier — biweekly sessions, sliding scale providers, community mental health centers, even free support groups — these are all real options worth looking into. You deserve care that fits your actual life.

Go to therapy if you can. And when you leave your first session crying, go get yourself something small and sweet. You earned it.

If you're in LA County or Riverside County and need support, here are real free resources — no insurance required:

Los Angeles County

• LA County 24/7 Mental Health Helpline: (800) 854-7771 — the main entry point for mental health and substance use services, available around the clock

• 211 LA: Dial 2-1-1 — connects you to health and social services across Southern California, including mental health referrals

• NAMI Urban Los Angeles: (323) 294-7814 or namiurbanla.org — support groups, education, and advocacy for individuals and families

• 988 Suicide & Crisis Lifeline: Call or text 988, available 24/7 in English and Spanish

Riverside County

• Riverside County Crisis Helpline: (951) 686-HELP (4357) — free, confidential, bilingual (English/Spanish), available 24/7; they can also connect you to other local mental health services

• CARES Line (Community Access, Referral, Evaluation & Support): Available 24/7 for Medi-Cal and Riverside County Health Plan members seeking mental health or substance use services — call 2-1-1 to be connected

• Riverside County 24/7 Mental Health Urgent Care: Walk-in locations in Riverside, Palm Springs, and Perris — open to everyone regardless of insurance or ability to pay

• TakemyHand.co: Live peer chat with people who have real lived experience with mental health challenges

• What's Up Safehouse Text Line: Text SHHELP to 844-204-0880 for free, anonymous, 24/7 crisis support from a licensed mental health professional

• 988 Suicide & Crisis Lifeline: Call or text 988, available 24/7 in English and Spanish

More resources/information to come...

ANNOTATIONS

¹ Research published in clinical psychology literature supports monthly maintenance therapy as an effective schedule for people who have completed initial intensive treatment and developed solid coping skills. A peer-reviewed study found that maintenance therapy was similarly effective at weekly, fortnightly, and monthly intervals for patients whose symptoms had remitted. (Frank et al., 2007, via Taylor & Francis / Journal of Psychotherapy Research)

² The insurance industry's standard for ending mental health coverage is tied to "functional improvement" — meaning the moment you show progress, coverage often stops, regardless of whether you've reached actual stability or just bare minimum functioning. Federal courts have repeatedly ruled against insurance companies for this exact practice, finding that cutting coverage upon improvement violates federal mental health parity law. (ProPublica, "Her Mental Health Treatment Was Helping. That's Why Insurance Cut Off Her Coverage." 2025)

³ Mental health care is 5.4 times more likely to be out-of-network than primary care — 17.2% of mental health visits versus 3.2% of primary care visits. (Milliman analysis of 37 million people, via Solace Health)

⁴ According to an analysis of 2019 National Survey on Drug Use and Health data, 23% of US adults with moderate to severe anxiety or depression who were not receiving treatment skipped or delayed therapy due to cost. (National Institutes of Health / PubMed Central, "Impact of insurance type on outpatient mental health treatment of US adults")

⁵ According to a 2018 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), two in nine Americans who identify as Hispanic/Latino face mental health challenges, yet more than half do not receive treatment. Reported barriers include lack of health insurance, cost, cultural stigma, language barriers, and limited access to culturally competent providers. (SAMHSA, 2018, via Charlie Health / Hispanic Research Center)