Therapy Budget Anxiety

Aside from the fact that my sessions with t aren't so much therapy anymore as they are life coaching or something similar, it's also a budget issue too.... it was one thing spending the money when it was therapy that I needed. But I can't see continuing to spend the money. I hate money!!! I think I'm going to buy a teddy bear, dress it in all black (like my t dresses ha) and talk to that instead!!!

Leah, you are spending money you don't have! Isn't that causing you stress? I'm not sure how much of a choice you have but to cut way down. It's a fact rather than a choice, cos what happens when the cards max out? I think you have yourself convinced that you can't cope without her, you're giving away your own power. I think you need to work out what you can afford without going into debt and go from there.

If you kept to the "budget" you initially set for therapy..... you'd have a lot more time AND a lot more money in your life... which would reduce your stress level.

I know it sucks making changes that you don't want to make... but that is a rather unfortunate part of life. If you get back to a spot where you can afford the time and money, then go ahead and increase your sessions again if you feel you still need it.

But in the meantime... it sounds like it would be a good idea to tell your T what you can afford and to ask your T to help enforce it.

Asia Blue, A Red Panda (and MANY others too) you are so right: I have even told myself this: that right now, I'm feeling pretty out of control in my life, lots of upheaval with family, work, school, finances.... so, if I can control my spending, it will definitely give me more sense of ownership and help tamp down my stress a bit.

I did tell my T what I could afford a while back, but haven't stuck to it. Yesterday, after I posted this thread, I asked her to change Thursday session to Friday, to make it easier for me to do one email session midweek instead of a midweek and a weekend one, and she said that was no problem at all. (She's so accommodating!)

I am scared to approach the topic as a whole, like "Okay, from now on, just cut me off at X point," but I think what I will do for a first step tomorrow is simply say to her- "I really need to wrap up at 90 minutes max, will you help me keep an eye on the time."

I'm like scared to even say that, but I bet I'll be glad once I do, and it should be easy to start with tomorrow, since that's my nice long session anyhow.

Then.... I will say the same thing on Friday: "Let's focus mostly on skills, and try to stick close to 30 minutes so I can have some homework time after." (Yikes...)

I swear I'm going to need pocket riders for just this one thing! It seems so silly, so trivial, but it's not. I can't spend twice as much as I've budgeted on therapy- even what I've budgeted is a challenge.

Just explain to her your worries over money, and the fact that you need some help workong on your self-control. She should be happy to help you accomplish the goal of managing your money better!

Does your T know that you can't really afford the amount you are spending on therapy? Even at her old rate of $80, if you're doing 7.5 hours of therapy a week, that's $600/week or $2400 a month! That's an incredibly substantial amount of money to spend on therapy!! For a lot of people, that would be pretty close to their monthly salary from a full-time job! For a therapist to simply provide as much therapy as you like and just keep sessions going until you say that you feel finished-- seems rather irresponsible. Doesn't she have other clients and a personal life to maintain? It seems a little questionable that she can simply make herself available and keep sessions going at your discretion. It seems as though you should establish some time boundaries, even if the money were not an issue. If your T also knows that you are putting all of this therapy on credit, and that you don't actually have the money-- well, that's even more irresponsible. To be spending money you don't have in a way that you can't seem to control is the definition of an addiction. It sounds as though therapy has become an addiction for you, and that isn't healthy. If you want to have a healthy relationship with your therapist and develop your own coping skills, I think you absolutely need to establish some boundaries. While many people struggle to pay for a very much needed hour/week in therapy, or struggle to pay for inpatient when it's really needed-- this is a different situation. It doesn't seem as though there is any need to be spending somewhere in the neighborhood of $2400/month for online therapy. Does your husband know how much you are charging for your therapy? Does he have a problem with it? After all, you are not only putting yourself in debt, but putting him and your whole family in debt. This may pose a real problem for your yourself, your husband, and your daughter down the road. A therapist who really has her client's best interests in mind would not feel good about allowing you to go into debt to pay for excessive services.

I have discussed my heavy therapy spending with my husband three or four times, not the exact number but told him I have charged some and that it's a major expense. He supports me in doing that much therapy. I'm not charging all of the expense: we have a solid income, but I am spending more than is reasonable within my budget, yes, I do need to cut back so that I'm not charging any of the expense at all, that's the goal. I also afford other important expenses: my daughter has a college fund, everything she needs, we have a home, etc., so it's something I need to get in line with my budget, but not spending I regret overall.

In terms of defining need, well, I'm not comfortable judging others need or having my own judged. Needs are food, water, shelter, oxygen, perhaps in some cases medication. The rest is discretionary spending. I'm investing in the quality of life that I want, and for my investment, and with hard work, I've made substantial gains in a one year period. I don't see it as too far different from a student loan, in a way. So, now, about seven weeks ago, I reviewed my budget and determined what I needed to do, and I haven't done it, so... here I am. My therapist will partner as much as I ask her too, but I am a grown, responsible woman, and it's up to me to choose how to manage therapy, so that's why I appreciate the suggestions, all of them, including to make her my accountability partner, but not as much the implications about 'foul play', haha.

I'm not incompetent, I just have this growing edge: I've brought my behavior in line, I've brought my career in line (promotion a few mos. ago and almost 3/4 through my degree program), and now it's time to bring my budget in line!

I don't understand why your therapist doesn't set the boundaries re: time limits. I see that as the T's job....

I should add, for clarity, when I disclosed to T that I couldn't afford to continue with the same amount of sessions, she made me promise to let her know if I could not afford her rate, and said it would be no problem if I could not.

She has told me in the past, sincerely, that regardless of my financial situation, now that we have an established relationship, she would definitely still continue seeing me even if I could not pay. She did not know I was spending such a significant portion of my income initially, so that was something I only disclosed generally in perhaps November or December, finances are a very difficult topic for me, hence... I am posting here, looking for help and partly doing it just to keep myself accountable.

I do have a retirement plan (though it needs work!) college fund for kiddo, insurance, etc., so... I am paying all my bills and such, but yes, I need to be more disciplined about my spending, because I would rather pay off the bills and spend on my house and such. Of course, a lot of the money spent in therapy was for my daughter. My primary issue was working on being a better mother. I'm really glad to have seen huge progress in that area.

Yes, several others have mentioned that concern too. My therapeutic relationship is unique in that my therapist is semi-retired and I work from home, a somewhat flexible schedule, so we just happened to both be in this uniquely complementary situation where this much intensive therapy was possible.

She was used to managing the time with prior clients, we did discuss that early in our relationship, and I was the one who asked for more open ended sessions. It's been a blessing to have this opportunity, but of course, everything is blessing and bane- it has its advantages and disadvantages, so... now it's time to rebalance things to maintain maximum advantage.

(((((((((Leah)))))))))))) sticking within a therapy budget when you know how much the contact helps, need the support, and don't like leaving things up in the air which happens ... is hard! I'm glad you and your T are able to discuss this and hope you can find something that works for you and allows you to keep getting the support and help needed.

Thanks very much. I'm going to try and post here a while to keep myself accountable. Just finished my 90 minute session. It was actually 95 minutes, so... 5 minutes over. I'll try and do a shorter checkin on Friday, like 25. (Also, I paid for the session in cash, well... debit card.)

The key now is not to ask for extra session time between now and Friday. We talked about something difficult and powerful, but I can just let it sit, and use my coping skills to deal with other stressors that come up between now and then.

I do have an email session going to tide me over until Friday, so..... I'll try to do that judiciously. Would be great to stay on target this week. Just have to keep the 'it's not enough' feeling at bay. I have lots of other useful things I can do though, projects, rest, music, exercise, go out for some lunch, etc. Anything is pretty much cheaper in my life than $100 an hour therapy!

Well, everything is a mess!!!! Things keep going wrong here, too wrong. I need my routine and I can't have it. I TRY to cope well with stress, but I just keep getting more stressors heaped on me. This last day, it was four disturbing things in the last 24 hours, and a few more the prior days. I can NOT keep up.

So, I went into my 30 minute session wanting to talk DBT, but she wanted to hear how things were going, though I'd already explained it all in detail in email to avoid that. I didn't talk well, was so upset, in a lot of pain from yesterday, and she said for DBT, go take a bath and have some aspirin and call her back after. So, I did. It was a good idea, but I'd already spent 25 minutes on the phone, so I SHOULD have emailed her and said "Let's call it a day, since we already talked most of half an hour, the bath helped, thanks, and I'll talk to you next week."

But I didn't. I felt like we had a plan I should stick to when she told me to call back, and that I wanted to do some DBT. So I called back, but she wanted to hear more about everything.

Damnit, I didn't even stick to my plan, and I REALLY wanted to do DBT. It's hard to be decisive. I am so tired, and not feeling well, and very very stressed, and I should have been more forceful. I told her again at the end I was frustrated, so she told me to do some reading from the DBT book and we'd talk about it next week, then she had to move my session next week which is the LAST thing I wanted to hear because I HATE routine changes. I already had 20 routine changes this week... I want something that doesn't change. I'm not trying to be unreasonable, I know life always has change, but mine has too much right now. I really really need peace & quiet for a bit.

I'm so mad. And hurt, and tired.

So, since she had to push back next week's session anyway... I guess no more email for this week, since I'm $50 over as it is, and next week, to make up for that $50, I'll just do one 90 minute session, I guess. I'm so torn. It's not easy for me to make this all work. My to do list is killing me, and my PTSD is a bit tough to manage today.

Wait though: I should say this- because I'm looking at everything "glass half empty" - this week.... I spent 3 hours worth of time. It's WAY better than last week, which was 5.5, and my goal is 2.5. I did a good job of cutting back! Really good. If I can just avoid writing to her again before Sunday, I can finish out this week knowing that I am close to my goal. It doesn't have to be perfect- I actually dealt really well with a TON of stress this week... it's just getting to me right now, the insanity of this week, and I am feeling it, but... that is bound to pass.

Also, she said I'd been doing more DBT than I realized (in general).

I should have read this thread before session, but was so busy and stressed I forgot. I was going to tell her "Let's focus mostly on skills, and try to stick close to 30 minutes so I can have some homework time after." (Yikes...) but I didn't. I have to put my foot down about what I need, I wish it was easier.

Damnit, just added a $35 invoice.

I paid her invoice with a note that I'd wasted an hour with her today, so would just be doing one 90 with her next week, since she didn't have good availability next week anyway.

I hate it when therapy's disappointing. Sometimes, it seems EVERYTHING is disappointing, and I'd be so much better off on my own, way less room for things to go wrong.

I'm so mad and can hardly stop crying. I was not forceful enough about needing to do the DBT work, which would have given me a MUCH needed break and healing resource for dealing with the unresolvable emotional stress I'm under lately. She changed my Fri. appt. to today, and I'm not sure when the Monday one will be, maybe Wednesday, and I'm really stressed about changes. I sent her an email about how bothered I am at my failure to communicate clearly enough that I really really really need the 30 minute session to be DBT. I had told her prior, and mentioned it today, but it wasn't enough, she isn't getting it. Her approach isn't working at times like this. She thinks the answer is always to share my feelings, but sometimes... the real answer is to shore me up, to let me do things that will calm me, give me more concrete tools to deal with so much stress and upset, not just to dissect it 100% of the time.

I sent her an email about that, but... I withdrew it. I can't afford another email session this week. We should be able to hash this out next week, it seemed clear enough after session- just a matter of me being more firm, but I'm just... spiraling, stressed. Hard to count on something and not have it work out when I'm really down already. Way too many things going wrong this week. If I can at least stop the financial bleeding at about 3 1/3 hours, that will at least be a couple hours better than last week.

One thing that nobody mentioned was did you call your insurance since the new year began. One of the ACA reforms was that all insurances had to have mental health coverage and parity. If your insurance still doesn't cover therapy then you might want to switch to another that does. It would still be cheaper than what your paying out of pocket.

Just a suggestion it might not hurt to revist the insurance issue.

Leah, i know you want to cut down the therapy hours, and i agree that you should, but maybe at times of high stress you could cut yourself some slack. MAybe a high stress week isn't the time to be denying yourself help. When things calm down maybe then you can cut your hours down?

Thank you very much.
Well, I do have health insurance with some mental health benefits, but my therapist is not covered and I do not want to switch therapists, so... I'm going to keep trying really hard to curb the time we spend to an amount I can reasonably afford. It seems awfully difficult, but I'm sure I can manage it if I keep using tools to deal with my anxiety, make the most of our time, and find some other outlets to feel better. Definitely a big work in progress. Thanks for mentioning the insurance angle.

Thank you. Gosh, I do agree with you, and this has been a very hard week. I was almost in a car accident last night, my daughter's ODD is acting up, I had a scare this morning that my husband might have cheated on me online, there was a death in the family Tuesday, and my husband has been home sick with me for two days this week with stomach flu. Also, I'm way behind at school and my department got cut almost in half a couple weeks ago, so my work (60 hours a week) is really really busy.

But the thing is... things always happen.

I keep telling myself to cut myself some slack, but stressful things always happen, so I don't know what to do. I'm just really tired. I tried to call a warmline, just to be able to talk for a bit, but it wasn't even working, really, ha, I got voicemail. Now, I'm starting my PM lecture for class, so there goes the evening, and I seriously have to get my homework done, but all I want is to cry and sleep.

that is an awful awful week tho, that is real crisis. There is always something but maybe it's about working out realistically what you can deal with yourself ( sometimes its a matter of tolerating your emotions and using your skills rather than instantly reaching for T) and what times really merit extra help.

I've been doing really really well with my skills til now.
Last week I got through my daughter having the flu and home sick three days, really horrid dental surgery, a huge blowout with my husband, school and the work cutback. I did really good. So... I think I've made progress using my coping skills. I did a lot of things to take care of myself, but now I feel really run down. I was counting on 30 mins. of DBT today to kind of shore me back up until our 90 on Monday, then today I found out she couldn't do Monday, might be Wednesday instead. Sigh.

I just feel like I can't deal.

I found an online free crisis line chat, and did that for an hour, helped me avoid a mess with my therapist, and got me through a bit better. It was better than hiring someone for now, just hoping to make it through to next week. Panic attacks and all this crying and trepidation about my obligations right now is hard to manage. I sent my T a brief email in reply to hers hoping that I was okay. That's probably the start of a paid email session, I guess, since I replied to her. I'll use it sparingly for a $35 charge early next week. That plus a 90 minute session will be like $185 and keep me caught up on my goal, since I was $85 over goal this week.

I did pretty good last night too, being so upset, I sent her an email, but then cancelled it immediately to avoid beginning a paid session. It is a good start, what I did this week to be more accountable about my spending, so it does not stress me out so much anymore. I have to remember, I'm doing this for my own good.

I swear to god, this is hard. My life is just too messy right now. At least I did well using a crisis line and am going to get some relief this weekend and keep taking care of myself as best I can. I didn't do anything wrong here.... most people would also be overwhelmed by the things that are overwhelming me right now I think.

This is actually really great because you have started to solve 2 problems. One saving money by not incurring email charges and finding an additional support option.

Have you ever tried getting a single case agreement? I went through a similar situation when my husband switched jobs and the mental health part of my plan was carved out to another managed care panel that my doctors were not a part of. They applied for a single case agreement with them.

Then I switched to another insurance once ACA kicked in that also has out of network in case the same thing happened (it didn't)

Most docs will fight for the insurance coverage for you but I have to say boy your therapist nickels and dimes you. I know it's probably a way of setting boundaries but if you're racking charges up it's not working. Probably the opposite because for me it would feel "ok" to email if I was paying a lot for it but if it were free I would not use it.

I wouldn't mind 7 hours of therapy some weeks though....

Yes. Yes they would! Please try to go easy on yourself, and remember that you are doing the best you can with what resources are available to you at this time

I don't think she nickels and dimes me per se.

Our work is paid out like so:

1. Phone calls and live chat are $100 per hour, paid by the minute.
(This is only because that is the format used by the service that we rely on to connect. The service takes about 50% of the fee. I wish she would use a different service, but she relies on them because they're successful and she has an agreement to be exclusive with them and not contact clients offsite, plus they make the billing and payment easy for her. $100 is quite reasonable for therapy, considering she has 20 years of experience in practice, along with her Masters and other educational credit and specializations. So for her, $100 an hour is really a bargain. The last therapist I saw, who was a bit more qualified, billed like $250 an hour and that was almost 20 years ago.)

2. Brief emails are free. A brief email is me getting a bit of reassurance, giving her a progress/success report, or discussing business, like fees, schedule etc.
(Usually though, I'll tack on a session request after to a brief email, so it's added on to a paid one, which is better for my record-keeping.)

3. Long, involved, therapeutic emails are $35 - $100
I write at length, so in a standard $50 or $75 email session, she's often reading somewhere in the neighborhood of 9 pages and replying three times, maybe writing a couple pages herself. An email session like that typically stretches a couple days, allowing for back and forth, and for me to give a detailed account of situations I'm struggling with. I've made a ton of progress on behavior modification with this service.

Also, she's not covered by any insurance because she works through that online service, not an official office, although her personal license is current, so I'd have to change therapists to do better, and I feel she's just right for me, lucky to have found her, so I really really would hate to lose her.