confused/upset by therapist, not sure what to do

I hope it all works out to your satisfaction, 78. Best of luck. In your pocket if you want.

just got home from therapy, and i feel like my head is spinning. we spent the ENTIRE session talking about all of this. i brought it up first thing (whereas normally i'd stall and/or fill her in about other stuff) and i kept looking at the clock like, "wow, we really aren't going to get to anything else!" it felt like kind of a waste of a session in that sense, or at least totally different from what i'm used to.

i told her all i had been feeling about cutting back, her not caring, my confusion about the single case agreement (SCA), etc. she just sort of sat there and didn't respond. finally, she said, "what does this remind you of?" (as in, from my past) and i told her i didn't know. (internally, i was thinking, "this reminds me of the current situation!" )

she let me talk some more, and then i stopped and waited for some sort of response from her. first she said that she didn't realize the SCA was still an option (even though i emailed her about it and talked about it in session) and that it wasn't much work for her and that she'd be willing to do it. then we started talking about all the finances, and she got pen and paper. she started writing down what i used to pay, what the insurance used to pay, what i currently pay, what the insurance currently pays, and so on. the odd thing is that i KNOW she doesn't offer sliding scale (to anyone), but i was starting to get nervous that she was going to offer it to me. i could just feel it coming. and then she did! i got really uncomfortable all of a sudden, and didn't know what to say. basically, she was asking me what i could afford per month, and then was working out the numbers to meet that amount. we talked about it some more, and i said things like "but then you'd be missing $17 from me each session" or "i feel bad that you're doing me this big favor." she said (somewhat harshly), "don't worry about the $17, i'm doing this so therapy is affordable to you!" then she said, "i wouldn't offer this if i wasn't comfortable with it. i'm totally comfortable with this, or else i wouldn't do it. you need to trust me on that." i just kept saying, "ok.. ok.."

i told her that the only way i'd be comfortable taking a discount is if we kept track of that discounted amount and then i sort of trailed off. she said, "so what if you win the lottery you can pay it off?" with a big smile and i said, "yeah, that." she was being nice and trying to make light of it since i was obviously uncomfortable, but i felt like there was so much i wanted to say that i wasn't saying. somehow, we decided that i'd look further into the SCA and if that didn't pan out that she and i would work something else out. she said, "the therapy comes first. it's not about the money, that's not what's important to me. we have a relationship, and i want to do everything i can to preserve that."

all of this was surprising to hear, as i've often wondered if she's in it for the money. i can't say why exactly, but i've always gotten the vibe from her that the money is the most important thing. anyway, the time was up and she asked if i was ok considering that i walked in and said i had a lot to talk about, and then we just talked about this. she said she wanted to take a few minutes to check in and make sure i was ok walking out. i told her i was fine (really, i couldn't think much at that point - i felt like i had so much to process) and then we did some scheduling stuff (like adding appointments on the "off" weeks). through all of this (like the last 5 minutes) we just kept staring at each other intently. i don't know why, but i felt it important to look at her, and she "matched" me in doing that. she's SO incredibly beautiful <sigh>. it was so intense. at one point though, she asked if i was ok and said that i had a funny look on my face

we stood up and i didn't think we'd hug as i've been sick this past week. she knew i wasn't contagious, but in the past when either of us is sick no matter what - we don't hug. so we were standing there, looking at each other, and i said, "is it ok if we hug?" and she said, "yes! of course!!" and moved into my space and hugged me. it felt good. we had a nice goodbye at the door and i left. then she called me a few minutes later to ask what she should do with my check. it was funny because she was like, "hey seventyeight, what do you want me to do with this?" all casual and stuff. the whole session felt so casual.

also, she's been wearing this awesome perfume (i think) the past couple of sessions and i can just slightly smell it when i'm there. it smells really masculine (like this men's hair product i used to use, actually!), and i can smell it a tiny bit now on my clothes. it's a really sexy smell, and i'm not sure what to do with that

anyway! i just wanted to fill in those of you that have been following along. thanks for reading.

also, for those of you that are on a sliding scale, how is that working out for you? i foresee feeling guilty anytime i spend money on say a shirt, like i shouldn't be doing that because i'm getting therapy at a discounted rate. can anyone relate?

I'm so glad you were able to talk about this with your T, and that it went so well. It must be such a good feeling to hear "the therapy comes first," even if you're worried about the financial aspect.

When I switched from 1 to 2 appointments/week, my T lowered my rate. I felt gross and guilty about it, and I sometimes worry about whether I'm there too much (she assures me I'm not), but my anxiety about it has certainly reduced over time. And really, it's made such a huge difference to be seeing her more often that I think any anxiety (on my part) and any per-session $ loss (on her part) is probably totally worth it for both of us. I can't explain it, but it's like I finally (after 3 1/2 years) feel the slightest bit secure, and we're able to get to things in more depth now. Otherwise it would have been years more of very little progress, I think.

And seriously, don't worry about buying a shirt or whatever else you do with your money. While therapy is a commitment and a sacrifice (and, I think only works when it really is those things), your T doesn't expect that you'll stop living your life otherwise, or that you'll stop taking care of yourself in other ways. I mean, if you do win the lottery, then maybe you should have a conversation. Otherwise, don't sweat it!

(((((((78))))))))

T gave me a reduced fee a couple of years ago when I had some big insurance confusion, and he told me at the time that I was the only client he had ever done that for. It was super super super uncomfortable for me. We talked about it a lot, and he told me what he needed (for me to come at certain times that aren't busy) and I told him what I needed (to pay less $) and I guess in the end it felt like a good compromise. But then my insurance came through after all, so I ended up not really needing the reduced fee.

In january, because of a change in my insurance, therapy is going to become unaffordable for me. I definitely won't be able to afford more than once a week, if that. The timing is horrible, and part of me is hoping he will offer a reduced fee...and part of me is terrified that he will.

Therapy is important and the money part of it can be really tricky. Let your T do this for you. It's a good thing and you are worth it.

I'm so glad it worked out. I think they don't take it seriously until they know for sure it is serious.I get guilty over EVERYTHING btw.

I struggled with the same issue. My therapist made me ask, she wasn't willing to offer. I drained my savings for a long time before asking. You were really brave to bring it up. In fact after spacing my appointments out, I now remember my T did make an offer and I accepted. I felt guilty and still wanted to ask, because that's what she'd wanted. She seemed to get more and more frustrated with me for not asking openly. Eventually I offered her a little less than what she charges but more than she'd offered me. It's still really hard for me to pay. I'm not sure how long I can continue, and I do wish I could just pay the full fee.

I too keep my own record of what I missed paying, so I can one day pay her back.

I'm so glad it went well with you. I thought surely your therapist had misunderstood somehow. It didn't seem like a normal reaction considering the duration of your relationship.

I also think those sessions spent talking the whole time about things like that are never wasted. It shows our coping abilities and thought patterns, and the things we get hung up on. A unique opportunity to see them all in real time, right there in the room. So I actually think it tends to help therapy.

I am glad your T made it clear that she is willing to work with you to find something that works so you can continue to stay with her. That's wonderful, whatever path you end up having to take.

so the way i left things yesterday with my therapist was that i was to call my insurance company, find out how to continue the single case agreement (SCA), and give her a call to let her know what she needed to do (which is call them, answer a few questions, and fax in a form). i called my therapist yesterday and left a message with the info, and just received an email this morning from her. she's now saying she needs more time to think about it (the SCA), and that we'll talk about it next time i see her and make a decision then. she said it's not about not wanting to help me, but about how she wants to run her practice.

i'm upset, hurt, and confused. it would be one thing if all along she said no.. but to say no (or at least, avoid the question), then say yes, and now say maybe - is very frustrating. it also makes me feel like she couldn't just be honest with me when we talked about it in-person yesterday (for 45 minutes!), and that she's only really able to be honest over email. (which is also bothering me - i find it odd that i would call, and that she would email me in reply. it makes me feel like she really does not want to talk to me directly about this.)

to have to wait another week for resolution on this, feels like agony. i want to take the SCA option off the table completely now, as the decision will be made and i can move on. i can't imagine i'll be happy if she tells me next week that it's actually a yes because of all the flip-flopping that's been happening. i want to take the control back, and just say it's a no now. should i call her? try to schedule yet another appointment just to talk about this? wait a week instead? let her decide? quit therapy altogether?

what would you do??

Ouch!! I'm so sorry she chose to say something like that by email. That was unfair to give you hope, and then take a bit away. I know exactly how stressful the wait is after things like this happen. It makes a week an incredibly long time. I hope you're able to tell her what you wrote here. I also wonder if it would help if you asked her if she could use your appointment times for phone calls and filling out forms?

It sounds like she's left things in a really confusing place.

I tend to agonise and hold on for a week to have important questions, like the ones you must have, answered. I wouldn't recommend that. I think when such big things are up in the air that it's not good for our mental health to struggle away not knowing. Is there a way you can request a conversation to clear things up...or email back?

Let her decide what to do on the insurance end. Some therapists and pdocs really struggle with insurance companies and their reimbursement/loops to jump through, etc. It sounds like maybe she's thinking she'd rather have you pay on a sliding scale than have to messing with the insurance crud now that she's thinking about it. That's not a comment on you or on her wanting to work with you. She's just perhaps preferring the idea of the sliding scale to the insurance set-up. Try not to make this about more than a business decision for her. Sounds like she's just done some thinking beyond your session about this, not that she wasn't honest with you in your session. Just that she's continued to consider the situation.

i understand what you're saying, but beyond the initial call/fax to the insurance company - there is NOTHING else she has to do with them. i submit the claims, they wire the reimbursement payment directly to her banking account, and i pay the difference. (she doesn't even need to sign the claim form, as i have a copy with her signature that i use!)

i spent much of yesterday thinking about the sliding-scale, and have made the decision that i can't accept it. i'm completely uncomfortable with it, for one. two, i don't like how arbitrary it is. when we were doing the math, she was trying to figure out what i could afford and kept changing the fee based on my finances. i know she was being very nice and generous, but it would have been easy for me to say, "no, that's still too high. what about this amount instead?" i think it would be different if she told me that she had a special rate for students or something like that, something pre-determined that everyone paid (which i know is not the point of a "sliding" scale, but still). i also don't understand why the sliding-scale is being offered to me now, when in the past i was struggling a LOT more financially, paying a lot more for therapy*, and she knew all of this. furthermore, my partner also sees this therapist and isn't being offered the reduced rate. so that feels really weird/yucky to me, and complicates the issue.

*the first year, i spent almost $14,000

back to the SCA - i really just don't understand why she'd say no, then yes, then maybe. it's very confusing, and makes me feel like i can't trust her. i keep thinking i should call her to schedule an appointment to talk to her about this, but i don't want to rush the natural decision-making process. plus, to spend another $150 on talking about this doesn't seem practical. but it's all really bothering me. ugh.

My issue with finances has been similar. I left an awful job at the same time as I lost my allowance for medical costs (which in total was about half of my therapy each week, not including other medical bills) and I wasn't offered a reduced rate. Every cent came from my savings. I worried, and stressed, and didn't think I could bring the topic up with my therapist, because she knew...and if she was willing to offer...well surely? She encouraged me to find more work to pay for therapy. The truth is that even with more work...I could barely afford the cost.

The money stuff is hard. It certainly brings up big feelings for me. My therapist will talk about stuff like this on the phone in between sessions and this is the sort of thing I'd request a phone call for (if I was brave enough)! I don't think you'll be rushing her decision process if you just need to tell her how confused and worried this makes you feel.

oh seventy-eight, im sorry you are dealing with this. it certainly doesnt help in dealing with the main issues you are attending therapy for in the first place. insurance companies do suck. from what ive gathered from skimming your thread is that your T really wants to accomodate you so you can keep coming but she sounds confused on the way to go about it. i dont think she realizes how much turmoil its causing you. to her, she knows that you guys have talked and she said she would do the SCA and then she'd do a sliding scale and in her mind i think that she is thinking you know either way that you are going to continue its just a matter of which route. im hvaing trouble keeping it straight but....would you be paying more doing the SCA?

I'm with Chris, if she offered you a rate that would be $17 less per session as you said above , that is $68 a month, at once a week. Yet for her to jack with an insurance company, who she would then have to report to and explain her services quarterly, and also do a little leg work each month she would be out $150.00 an hour. As time is money when you run a practice, you only get paid when client is in the office and the meter is running. So even a 10 minute phone call cost her $150.00, its a full hour she can't see a patient. I think you should accept what she is offering as a caring gesture from your T, It's not charity its generosity. At the end of the day, its better for you NOT to have an insurance company involved as nothing goes on your permanent record. I hope you work out a deal that pleases you both!

thank you for your responses. to answer your question, struggling2, the SCA and the sliding-scale would be about the same for me financially. both would be about a 50% reduction in her fee. the main difference between the two is that with the SCA she would end up getting the full fee (partially from me and partially from the insurance company), whereas the sliding-scale would end up being a loss for her. i said before that it was $17 off, but it would actually be $37 off - so a net loss of $148 per month on her end.

lolacabanna, she has told me explicitly that the insurance piece isn't any extra work for her - aside from the initial call/fax. she does not have to "jack" with them at all, report and explain anything to them quarterly, or do any other leg work each month. in fact, just to be sure, i asked her about this again yesterday and she confirmed this for me.

i ended up calling her this morning, and leaving a long message about how i am feeling. she called me back later and left a message saying that she wasn't trying to make me feel "uncomfortable or nervous" about all of this, but that we should talk about it further. she then called me back a half-hour later (i was in meetings both times she called), saying that she didn't want to keep me waiting any longer. she said that she had made a decision, and that was that she doesn't want to work with the insurance company (aka do the SCA). she reiterated her sliding-scale offer, and said we would still continue to meet once a week. interestingly enough, as she was talking about the insurance, she said something about it in regards to her other clients. it's hard to explain, but i'm finally understanding that her distain and unwillingness with that is not necessarily about my insurance company, but insurance companies in general and her past experience with them. this is also consistent with the things she has said in session about insurance companies, and for some reason i didn't put it all together before.

anyway, i called her back and thanked her for the messages. i told her i was relieved that the decision was made, and that i appreciated her just telling me what was up. i then went on to tell her my feelings about the sliding-scale. i told her i wasn't willing to accept it, and gave her four reasons why:

- i feel like it would change the boundaries
- i would feel less important of a client if i was paying less (like if she had the choice between giving me or someone else a certain appointment, the full-paying client would always take priority)
- i wouldn't feel comfortable calling her outside of session if i needed to talk, like those benefits are reserved for full-paying clients
- i'd feel guilty if i went out to eat or shopping, like any extra money i had should be going towards therapy

so, that's that. i went on to add that it's been nerve-wracking to handle all of this over the phone - actually, over voicemail - and that i was feeling insecure about our relationship. i told her that i wanted to make sure that everything was ok and that nothing has changed between us. i asked her to call me when she could, so that we could just check in for a moment.

so.. that's the latest. again, i really appreciate everyone's feedback. it's been really nice to be able to work through and process a lot of this stuff on here with such great support.

I understand those concerns. I think I wrote down a list of them when I accepted a reduced fee. It still concerns me a bit, but not for a second has my therapist treated me differently or like I was less important or less deserving of her time. She's been quick to point out that just because those are my concerns that they are not thoughts shared by her. She also tells me that at the end of the day it's just money, it's just a transaction. Just because it brings up huge feelings for us doesn't mean it does for them. I think you should definitely go and talk about this all again in person. There's no need to be ruled (like I was!) by these negative ideas which are probably completely unfounded.

That was what I was trying to explain concerning how many T's and pdocs really have an utter disdain for dealing with insurance companies because they don't like the insurance companies having say in their treatment of their clients.

I think you need to explore your reasoning for rejecting the sliding scale. These are your beliefs, but they really aren't based on fact, just on your own personal beliefs and feelings.

I paid my 1st T on a sliding scale (very sliding if you know what I mean). Our boundaries did not change one iota. I was never treated any differently by my T. As far as "feeling" like you can't call or can't spend money goes, that is all on you and those are mistaken beliefs that you can work on and work through if you are willing to accept the help and generosity of your T who is quite willing to work with you this way and in fact prefers to work with you this way rather than to have a 3rd party insurance company dictate any conditions on your treatment.

Think about that. Your T wants to ensure the BEST care for you, and she feels this will be the best situation for both of you. Can you consider trusting her judgement and expertise on this? Or are you going to stay stuck in your mistaken beliefs about this situation and refuse her help? That's what this really comes down to.

in every reason i mentioned, i used the word "feel." these are my feelings, not my beliefs. and they are certainly not "mistaken."

I'm not saying this to be judgmental at all, because I felt exactly the same way myself, but is it possible that you feel so uncomfortable because you believe those mistaken thoughts? You're feelings aren't for no reason, you feel the way you feel, but there are other ways to think about the situation which may also begin to change the way you feel about it. I can only be so sure about that because I worked through it a fair bit myself. Like I worried that I'd be less important to my therapist or less deserving of her time (particularly outside of my appointments), but she hasn't treated me that way for a second, or changed her opinion of me at all, so although it was a valid concern and feeling, I no longer worry that I'm less important to her because of the money side of things, because she's shown me that it's not true.

This money stuff can also bring up other important stuff within therapy too. I realised how caught up on money I always was. I even realised that I felt I'd taken advantage of my mother as a young child any time she spent money on me, and so on. I was having such a big reaction because I felt I didn't deserve money from other people, and as a child I began to worry about money and needing to be the one in control of finances. So accepting what my therapist offered was very hard for me. I thought all of the same things you listed, as well as things like I didn't deserve to take it whether she offered or not.

Money is hard, your feelings aren't wrong, but I do think you need to talk with your therapist about this all again.

But if your feelings are based on mistaken beliefs, then your feelings can change when your beliefs become more based on reality. It isn't that your feelings are mistaken--they are what they are--however, if your feelings are being based on beliefs that are quite possibly mistaken (and beliefs are thoughts, not feelings), you can fact-check your beliefs and bring your feelings in line with the actual facts of the situation.

Example: I may "feel" shame and worthlessness about myself, but those feelings are based on mistaken beliefs that I am broken, a bad person, and I cause trouble for others, which I bought into very young at the hands of my abusers. If I fact-check my beliefs--my thoughts--about being broken, bad, and a trouble maker, I realize those beliefs really aren't reality.

My abuse has not "broken" me; I am a wife, mother, teacher, I function in society. I am not a bad person; I have a good heart, live a pretty moral life according to my value system, etc. And, I really didn't cause problems for others; my ABUSER caused the problems; I was the victim of HIS trouble-making.

If I can acknowledge the above as fact, then my feelings of shame and worthlessness that stemmed from those mistaken beliefs can begin to change. My "feelings" don't hold up quite so well in the face of the reality, so when I "hear" myself thinking those thoughts and feeling those feelings, I have some justification for challenging my thinking which eventually helps lead to an adjustment in my feelings in the long run.

Does that make any sense?

yeah, probably. but it all feels so strong to me, so it's hard to tell.

i hear what you're saying, but i don't know if the two (beliefs and feelings) are really related in this case. for instance, if i feel guilty for going out to eat, i feel guilty for going out to eat. i'd have more money to do so if i was getting a discount on therapy. that is a fact, not a belief. so i really don't know how they're related.

my therapist called me this morning and left a long message in response to my call on Friday. she said that we should really be talking about all of this in session as it's "therapy stuff" - my feelings on not wanting to do the sliding-scale. she also commented on the insurance piece, and said (several times, actually) how she doesn't want to spend her time dealing with it. she was very adamant about that, and i'm confused as to where all of this is coming from. i never once tried to convince her to do the insurance, and i completely respect her decision not to do so.

again, it leaves me feeling like she's either getting me mixed up with some of her other clients, or that she's just lumping all the insurance stuff into one group. i don't blame her, but i'm starting to feel like a lot of this is misdirected. i left her a message to say much of the above, and apologized for getting into to much of the "therapy stuff" over the phone. i told her i just thought i should give some explanation as to why i wasn't willing to accept her sliding-scale offer.

i'm still mulling over the sliding-scale thing. the only thing i can think of in the plus column is that if i agreed to it, it would be more money in her pocket on a monthly basis. like if i didn't do it and went twice a month, she be getting $234. if i did do it, i'd be going four times a month which would be $452, almost twice as much. true, it'd be twice as many sessions (or twice as much "work" for her), but maybe that part is worth it for her. i don't know.

i did want to say to those of you that are on sliding-scale: my thoughts and feelings about it are totally about me, and not a judgement about any of you. just because i would feel guilty about it, for instance, doesn't mean that i think you all should feel bad for doing it. i hope i'm not coming across that way.

What if your T tells you that she feels it will not change the boundaries, that you will NOT be less important to her, that she is okay with your calling her outside of sessions just as now, and that she doesn't believe you should feel guilty for spending money on eating out or shopping. I know they are your feelings, but, as farmergirl said, they may be based on faulty reasoning. If your T didn't want to offer you the reduced fee, she wouldn't.

she actually did tell me all of that, in her voicemail this morning. she even added that she was "absolutely, one-hundred percent okay with it."

here's an example though of where it gets complicated (for me):

i just got a bonus at work. after taxes, it was about $800. it gives me a TON of relief to have that extra money in my bank account, as i'm usually down to my last $10 right before payday. i've even run out of money before, or had to do things like take food out of my grocery cart because i didn't have enough or not drive somewhere because i didn't have the money for gas. but now i feel like i can breathe again. furthermore, now i have money for christmas gifts and to buy myself some new clothes (something i haven't done in a long time).

so.. do i tell her about this money? do i use it to pay for therapy and have my account go right back to where it was? do i not say anything?

on the one hand, it's none of her business, but on the other, it totally is. if i'm sharing my financial status with her and she's offering me a discount because of it - and then something changes - doesn't she have a right to know?

Imo, get your needs met first with the extra money. If you need food in the house, buy food. If your clothes are falling apart or don't fit anymore, then buy some new clothes. But maybe to reduce the feeling like you just spent a ton of money on something for yourself instead of her, you could go to thrift stores etc and buy clothes from there just to fulfill the functional side? Use it as a buffer. You can even set aside part of it for therapy sessions, that way you feel like you still used the money for therapy and you didn't spend it elsewhere right after getting a discount.

Just an idea~

She offered you a service at a reduced rate, because she doesn't want to deal with an insurance company. It is her prerogative to do so and you shouldn't feel guilty about it as she has a CHOICE and you too have a CHOICE if you accept or not. The extra money pocket this month happens to be an anomaly and should be used as you see fit. If your T wanted full payment she would utilize your insurance, but she is choosing not to.