[PeeJay]

Would you terminate therapy over this?

I pay out of pocket and I'm not super wealthy but it's an investment in myself.

The cost, as I calculate it, is a quarter ($0.25) for every six seconds of T's time, or $130 per hour, or $6,240 per year of 48 sessions. In terms of what I spend money on each year, it is probably right after rent and gas and food.

I sacrifice vacations and eating out to make this work.

I barely bug my T outside of session. I truly try not to be too big of a burden. But I guess I have really critical expectations about response times when I do have a minor scheduling question.

T's email system spam filter was sending my simple administrative request to the junk folder. So I didn't hear back from T in days and I got worried. Then there was some more mess around that, just with not knowing if emails were going through and then T not following up and playing phone tag and not knowing if T got my messages.

Then I had a really tough week (the hardest in several months) and T was on vacation. And I'm like what am I paying for if T isn't there for me during that crucial period where I was feeling overwhelmed. Once again I was left to deal with my own s*** on my own.

And then finally, because I really missed T and needed T last week, I asked for a copy of T's notes to tide me over while T is gone. But the agency copying fee is more than $1.00 per page and it takes 14 days to get a copy.

I'm so insulted. I feel like I already paid for those notes by paying for the sessions and that the copying fee should be an admin charge of five cents but no more. I feel fleeced and dis-empowered and way too vulnerable. And a two week wait, at such a high charge!

I guess that I am super worried about being too dependent upon someone whose attention costs 25 cents for every six seconds (like a taxi meter running), and who charges a lot per hour but then has crappy computer system and overcharges for simple services like copying.

If I were in crisis, I doubt I could reach T. I don't even know if my emails are going through.

I know I'm overreacting. But I'm so angry and so livid and I can think of less stressful ways to spend that money.

I want to just never see T again. The thought of actually even discussing any of this is so terrifying, I don't think I could do it. And what if that conversation takes 10 minutes? That costs me $26 just to discuss the rupture!

I think I'll go cry alone now. Okthanksforlistening.

[unlockingsanity]

Is this something you think you can discuss with your therapist?

I think it's going to be very hard to be successful in therapy when you are focusing on the cost per minute, etc. That kind of thinking is going to keep you from focusing on yourself and the bigger issues you need to work on.

However, I understand that paying out-of-pocket is expensive. Do you have health insurance where you could see another therapist and pay only a copay?

Some of the issues you mention such as your email getting blocked, your T going on vacation, and the cost for records being copied, are common things that could repeat itself again even if you transfer to another therapist. They are not things you should take personally, although I think you are going to need to talk to your therapist about them if you decide to continue to see this T. You know what you are feeling, you just need to be able to express it...perhaps doing so in writing and handing it to T at the beginning of a session would be helpful. When you say you don't want to see T again, it seems like you don't want to be vulnerable. This is something to talk about.

I really think before you decide to terminate or not you should consider more important issues such as the overall relationship with your T...do you think you have made overall progress with this T? Has this T responded well when you have tried to discuss issues with him or her?

[Perna]

Originally Posted by PeeJay

I guess that I am super worried about being too dependent upon someone whose attention costs 25 cents for every six seconds (like a taxi meter running), and who charges a lot per hour but then has crappy computer system and overcharges for simple services like copying.

If you are just buying attention and copying services from T then I agree, you should quit. But I think the thing about taxis is that they take you somewhere you want to go? My T did not take notes (at least not while I was there) and I have never heard of being able to buy a copy of them but I can see how that might be comforting when T is away but it is just one of several ways you can probably think of to help soothe yourself?

I think of therapy as being kind of like a course in college. If working with T during your therapy hour is working for you, then I would not let the administrative stuff get you down?

[Nerak67]

I think you might be struggling with something I struggle with. That I am paying t to care about me. That I am just t's job. That I can be suffering terribly and t is going about her life unaffected or concerned. Yes, I have transference issues.

The email spam folder thing is a common issue and not personally done TO you. T's vacation is a common event; obviously they can't schedule their vacations around their clients' crises, so again, it was not personally done TO you. The cost of copying records is pretty standard no matter where you go, so again it is not personally being done TO you. The cost of therapy IS expensive. I get that, but it is what it is. They have to earn a living and pay their bills to, so even that is not really being done personally TO you.

Perhaps what you need to work on, as others have said, is that struggle many have with thinking their T's don't really care because it is "just a job" and they are "getting paid to care". They can earn a living and still care about their clients. One doesn't exclude the other. Sounds like a good topic for a session.

[PeeJay]

So, I've posted before on these forums that I don't mind having to pay. Or rather, it does not generally bother me. I like paying because it's the only way I can give back to T.

What gets me is that the hourly rate is so high and I've made this a priority in my life and yet the administrative stuff gets in the way of the therapy and triggers all these abandonment issues and these things are easily fixed.

I posted to another thread:

You can't have Neiman Marcus prices and thrift store service.

You can't charge a high amount for copying and then have it take such a long time. You can't charge so much for the T's time and then have T not respond to simple emails.

And I did soothe myself during my tough week. That's the thing - I'm paying for T for *extra* support on top of the self soothing. I want the notes to help be part of this extra support and it's a lot healthier than self-injuring or alcohol or something destructive.

I'm just pissed about customer service and with any other business, I'd ask for a discount but therapy is hard enough.

I don't expect T to fawn all over me or treat me as special.

And finally, I'm a records hound and I've never paid that much for records. States have limits on copying costs, here, it turns out.

Per HIPAA, "under the Health Insurance Portability and Accountability Act (HIPAA) a covered entity can only charge "reasonable" cost-based fees for providing the medical records to patients. See 45 CFR 164.524(c). Arguably, fees that are not cost-based, even if permitted by a state statute, may be contrary to the HIPAA regulation and therefore preempted by this federal regulation."

Medical Records Copying Charges: State Statutes: Law Offices of Thomas J. Lamb, P.A.

[Nerak67]

My t would say I am paying for my 50 minutes nothing more. I've just had to let go the thoughts about how much I am paying (more than you). My t would also remind me that she lowered her fee for me. Accepting that this is a business arrangement is hard. I've struggled with it.

[CantExplain]

I found it very difficult to accept how USELESS a therapist is in a crisis.
They should spell that out at the start.

[elliemay]

No, i get how you are feeling. It's not the money per se - it's the sacrifice with very little in return. "You know for what I pay you, couldn't you at least *not* let my emails go into your spam folder? Is that too much to ask?"

I totally get this. If this were a plumber you would have fired them, but in therapy you have to pay to tell someone how they screwed up!

I say write a letter summarizing your concerns and leave it for your therapist. Tell them it is rising to a level of upset that is reaching termination.

Give them contact info for you in the letter. Ask for confirmation that they have received the letter.

You should get some kind of response. If you don't, then another therapist might be the way to go.

Good luck.

[PeeJay]

Originally Posted by elliemay

No, i get how you are feeling. It's not the money per se - it's the sacrifice with very little in return. "You know for what I pay you, couldn't you at least *not* let my emails go into your spam folder? Is that too much to ask?"

I totally get this. If this were a plumber you would have fired them, but in therapy you have to pay to tell someone how they screwed up!

I say write a letter summarizing your concerns and leave it for your therapist. Tell them it is rising to a level of upset that is reaching termination.

Give them contact info for you in the letter. Ask for confirmation that they have received the letter.

You should get some kind of response. If you don't, then another therapist might be the way to go.

Good luck.

Yes! You said it better than I could!

[Wren_]

I wouldn't terminate therapy over those reasons alone ... but I would take the suggestion elliemay gave about writing to your therapist or otherwise discussing it with them and see how they respond and go from there
I can understand your concerns with this

[Rive.]

It does seem like you are investing (both financially and emotionally) in therapy but are not getting much in return? The issues you mention re not being able to get hold of T (phone tag/email problem) or T not being available is problematic. I see what you mean: what is the point of having a T if they are so elusive?

I think this is the key thing to discuss with your T though: "If I were in crisis, I doubt I could reach T. I don't even know if my emails are going through".
Please address this with T before making a decision to terminate, explaining your fears and the issues with reaching them (email/phone) and if you could both arrange a system so you can get through to them? Maybe see if there some sort of cover T (or what else to do) if you are in crisis and T is away?

It is hard to advise you what to do but the main thing is to ask yourself if you do benefit from seeing this T & weigh up the costs and benefits before making a decision. If the costs (both emotional investment & financial situation) outweigh the benefits, you might indeed consider another T. But see if you can (both) sort out the niggly email/phone problem first...

[feralkittymom]

You can't charge a high amount for copying and then have it take such a long time. You can't charge so much for the T's time and then have T not respond to simple emails.

I get that you're upset, but these^ things seem like distractions and not the underlying reasons why you're upset. Copying costs include reasonable charges for the labor/time involved, so $1 a page is not unusual from my experience. Your e-mail going to spam is also not unusual, as your address is probably not in your T's contact list; that can be remedied. I think a client deserves a clear and reliable system of contacting a T--mine used a drs answering service, but that was before e-mail was so common--but the point is, that can be arranged. Unless these actions are part of a more serious pattern of invalidating or disregarding you, they aren't irremediable. This is all pretty low priority stuff in the greater scheme of things, so the question goes back to what are you really angry/hurt about? Or, what are you trying to avoid by magnifying these issues and using them as a reason to consider terminating?

.
I struggle with the cost of therapy too and I struggle with the concept that things take a while to get better. For the cost, sometimes I want a solution NOW. But, I can't work through an entire screwed up childhood in brief therapy, or therapy that focuses on skills or homework, etc. So I made the choice and now I am really broke, but ...

As for T being available in crisis, I don't know how to answer this one. I think sometimes clients define crisis differently than T's and hence a response might be based on their judgement as opposed to your feelings.

Oh, I totally think the photocopying cost is bogus. But, I think many "practices" do that.

[mixedup_emotions]

There certainly may be underlying feelings/issues that need to be addressed, and this *could* be a distraction from something deeper.

But one thing that's clear is that it's a situation that has triggered some strong feelings, and expressing those feelings and giving it an opportunity to be worked through (as opposed to being repressed just so it can resurface at another time) is worthwhile.

There's certainly nothing wrong with having certain expectations and working through it. My T's office charges $15 for an overview of charges, so they encourage you to ask for and hold onto your receipts. Because of their antiquated system, gathering up this info is not an easy task for them - so they seem to feel justified in clients paying $15 for a copy. If, on the off chance that I need a copy, I probably would feel frustrated about that fee....and might even ask to have the fee waived.