(she forgot to get authorizations for this year and didn't realize it until July. My insurance doesn't want to pay, so she has to submit an appeal and letter of medical necessity).

I question what she's saying a little bit. She has known that she needed to do the letter of medical necessity for at least a couple of weeks now, and as far as i know, there is no real deadline for it (although it does have to do with her agency getting backpay).

Her agency is probably on her to get on this so that they can get some money. I don't think that paperwork is a favorite activity for therapists (or anyone else). Putting this stuff off is very common.

If she is being truthful that she couldn't respond because she'd been working on the letter of medical necessity, then why didn't she say so initially when she replied that she didn't have time to respond to my concerns? It would have made me feel a lot better to know that she hadn't just blown me off. I don't understand what reason she would have for not telling me this initially. A small part of me wonders if she's trying to make me feel guilty.

It seems that you have specific requirements for your therapist in how she needs to respond? Is this realistic? When we put specific requirements on others behavior this takes away a lot of power and control from our own lives (because this makes us dependent on the actions of others). You tell us that this is not about her, it is about you, so maybe it could be helpful to you to shift the focus to you and what you need to do about your triggers here??????

she knows how badly i feel when she can't or doesn't reply. So i just don't understand why she handled things this way. It just feels like she could have easily provided the reassurance i needed but chose not to.

It's just that my t knows this kind of thing is a huge trigger for me, so i can't believe she didn't take the time to write a couple of sentences to provide reassurance and let me know why she was not responding.

Are therapists really all knowing? I think frequently we think that others understand so much about us when they really don't. No one is a mind reader. Your thoughts are very clear to you but this doesn't mean that they are clear to others. It isn't other's jobs to take care of us anyway. It is our job.

So knowing now makes me feel guilty for having said anything. Had she told me what was going on, i would not have felt hurt OR said anything.

Is this a cycle from your past? With your mom or anything? (Asking for something, not getting it, some explanation later, then guilt????)