Wow!

I hate to say it, but yes, you need to send that letter. Your therapist can't know how to make things better if he/she doesn't know what they are doing wrong. Communication is important. You are paying them for a service, you have the right to ask for what you need.

I hope you do make that step and ask for more help. Don't just quit therapy when you've made it so far already. You can do it!