Dear Alice!

I have a close friend who has a number of rather difficult issues. One of the most important is a long history of abuse (largely psychological) from her mother during her childhood. (She is now 19.) It is incredibly difficult to talk to her about any of these things. I would like her to see Psych Services, but I am worried about the fact that there are only a limited number of sessions available — that is actually one of the reasons she has offered to me as to why it would be a waste of time to go.

Unfortunately, the only medical coverage she has is through her mother's medical insurance, she has no real money outside of her parent's control — it would be extremely difficult for her to pay for counseling, in other words, without alerting her parents.

What can she do? What can I do?

Dear Reader,

You're a great friend to be reaching out to try and gather more information about getting your friend to help she may need. The short answer to your question is that although you see obstacles in the way of getting your friend help, you (and your friend) do have options. If your friend is a student, she may be able to access the school's counseling center. Often, these services are provided by paying a health fee to the school, so insurance isn't involved. You may find it helpful to verify the number of sessions that are available to students. Even if the school does have a limited number of sessions, they may be able to help your friend and get her connected with additional resources. If not, you might check out Finding low-cost counseling in the Go Ask Alice! archives for possible options.

You may find it helpful to check in with your friend to see whether or not she actually wants help. It's great that you're a concerned friend, and you can certainly share those concerns with your friend. That being said, before sharing information with your friend about resources, it can be helpful to find out first if your friend has any interest in seeking help. If she does, that's great and you can share everything you've learned about the resources that are available at her school. If not, you can continue to let her know that you support her and will continue to be a supportive friend. However, there is only so much that you can do and you can't make your friend seek support if this isn't something in which she is interested.

Many colleges and universities provide short-term counseling to students. This service is often covered by the health fee, and therefore is no additional cost to the student. Along with determining types of therapy that may be beneficial, mental health professionals might also assess the amount of time that may be needed for a student and therapist to work together. Some individuals might be helped in a few sessions, while others benefit from a longer-term relationship with a therapist where trust builds over time. If students need a long-term relationship, the counselors at the school may continue to see them on a long-term basis or may assist the student in finding an off-campus therapist, who may see them over a longer period, depending on the needs of the student and how each school handles therapeutic relationships. If your friend still has concerns about going to a school-based counselor, you could offer to go with them, to the waiting room, or even to the appointment.

You also mentioned that your friend is covered by her mother's health insurance. Your friend, then, has the option to pursue coverage under that health insurance. In that case, however, her mother could, as the primary policyholder, be provided with information about the services being delivered. So, her mother may be able to see that she's going to a mental health professional. However, the exact topics being discussed during appointments aren't disclosed. Understandably, your friend wants her records to be kept confidential. Under the Health Insurance Portability and Accountability Act (HIPAA), a patient's mental health care records are never shared with anyone, not even their parents, without explicit permission. So if your friend chooses on- or off-campus help, her mother doesn't need to know or find out about what's being discussed, unless she chooses to share.

If neither of these options seems like they could work, your friend might consider reaching out to support groups for survivors of child abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a Behavioral Health Treatment Services Locator that can help your friend find resources that could be helpful. This resource may help your friend find some support while she determines her next possible steps with seeking therapy.

Hopefully this information can empower your friend to get the help she needs and deserves. If you still have questions, consider checking out the Go Ask Alice! Emotional Health archives.

Alice!

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