Alexandria's Project SAFE Owner Notes Challenges With Insurance Covering Therapy

ALEXANDRIA, VA — More than 20 years ago, Gayle Alexander and her business partner founded Old Town Alexandria therapy service Project SAFE in a time where mental health stigma was more heightened. That stigma has lessened, but challenges in the digital age have heightened the need for mental health services.

Their goal then and now has remained the same — making therapy not taboo and less intimidating.

"We opened Project SAFE for individual, family and group therapy, and we really wanted to empower families and kids to solve problems instead of being viewed as their diagnosis or broken and needing to be fixed," Alexander told Patch. "We really had this idea that we wanted people to recognize that again, it's okay to not be okay, that everybody has things that they're working on, and how to kind of connect people together and have them not feel quite so lonely and feel like 'I'm the only one that feels like this.'"

Five years ago, Alexander went through her own personal struggle with the death of her business partner, Stephen Maczynski. Today, Alexander is the sole owner and clinical director of Project SAFE at 665 S. Washington Street. She leads a team of fully licensed counselors, resident counselors and interns to serve children as young as 7 or 8 up to adults.

The team includes a portion working toward becoming fully licensed professionals. She says licensed resident counselors at Project SAFE had graduated with their master's degree, but they need 4,000 supervised hours to meet Virginia's strict licensure requirements. Alexander also is a site supervisor for interns pursuing a master's degree.

While there are different price points for therapy services, insurance coverage of mental health continues to be a challenge. Project SAFE does not take insurance, but clients can get a bill to submit to insurance. However, it is sometimes uncertain if insurance will reimburse them.

"Most of my colleagues, and including a lot of my even psychiatrist MD friends, do not take insurance at all anymore because the insurance will deny claims for no real good reason," said Alexander. "They'll deny group therapy because they'll say, 'well, we don't authorize that. They don't need it.' They don't have any idea whether the kid needs it or not. I've had insurance companies deny claims saying you have the wrong diagnosis code when I didn't."

Another recent challenge has been Congress pulling back on telehealth flexibilities for Medicare recipients.

"I understand there's pros and cons of being in person therapy and being online, but there are certain clients that won't come in person, or they don't have a car, or they can't get to you, or they can't take that extra hour of travel time, and so it's limiting who can come to therapy," said Alexander.

ADHD and depression are common topics counselors will address with clients. Alexander has also seen a trend of increased anxiety among clients, particularly social anxiety due to declines in communication skills. She pointed to the rise of online communications and how it contributes to less direct socializing.

"It's really isolated kids, so that they don't really have to leave their rooms or their homes, and so that feels safe," Alexander said. "And then this level of social anxiety kicks in, and then they don't want to go meet them at Starbucks or go out to eat or go to the park, so then we find that they're really disjointed instead."

She added, "In addition to that, there's the comparison game. We'll look at what somebody did on Instagram, and look how many likes this person got. Or, you know, are they TikTok famous? So it's really added a layer of self comparing and judgment in a way that I think is really in your face. And then it's caused a level of loneliness, anxiety and lack of verbal skills."

While individual and group therapy sessions look different, they often touch on similar topics.

"In an individual session, you might be talking about how you're managing your anxiety, or how you're managing your attention deficit disorder, or what struggles that might bring about at school, or how you're managing your depression," said Alexander. "Whereas group, maybe it's a little bit of a lighter topic, but you're recognizing, 'oh gosh, I'm I'm not the only one that is struggling with organization, or I'm not the only one feel sad, or I'm not the only one whose parents go, yeah, no, you got to turn in your phone at night,' so it really helps normalize from the group.

Because therapy can be uncomfortable, particularly for children, Project SAFE keeps items like fidget toys to help kids reduce their anxiety. Counselors may also get them to draw, do something to earn a snack or ask about something well in their lives.

"One of my points is we're not going to sit there like, 'okay, what's wrong? Sure, we want to get that, obviously, but we really want to help them focus on what the strength is too," said Alexander.

Alexander usually cannot give an answer on how long an individual client will need therapy. She says "brief solution focused therapy" to find strategies for one problem may work for some clients. Others, especially younger clients, may find the consistency of long-term therapy beneficial.

"It is very unique to what each person wants," said Alexander. "And that's what I tell people — there is no right or wrong, you might just need a couple sessions. My job is to actually work myself out. And then we also have those families that you can see are needing maybe that little bit of that longer support, and we are definitely available and there for you at that."

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