How often do you see your T?

I see my t on a sliding scale. There is no way that I could afford his full fee. I felt a bit bad about that to start with. Still feel embarrassed when I pay. I'm really only paying him a token. Not even paying 5% of his full fee... But I can't afford a great deal. That was part of why I was so embarrassed to say that I wished I could see him more.

Sure people have to eat but I think that most therapists make a fair bit more than the bare basics. I don't begrudge them that at all (I just say this because I think that most therapists can afford to do some sliding scale work).

There is a hope that health insurance will kick in and pay 80% of the visits (starting this year because I've sat out the pre-existing condition exemption in the first year). But I'm fairly sure the intention behind paying 80% of specialist visits isn't to fund therapy twice weekly! I'll put in a claim and we will see... But yeah I do feel a bit bad about him seeing me for less. But if he didn't agree to do that... Then I couldn't see him (or anyone) at all.

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alexandra_k said:
I see my t on a sliding scale. There is no way that I could afford his full fee. I felt a bit bad about that to start with. Still feel embarrassed when I pay. I'm really only paying him a token. Not even paying 5% of his full fee... But I can't afford a great deal. That was part of why I was so embarrassed to say that I wished I could see him more.

Sure people have to eat but I think that most therapists make a fair bit more than the bare basics. I don't begrudge them that at all (I just say this because I think that most therapists can afford to do some sliding scale work).

There is a hope that health insurance will kick in and pay 80% of the visits (starting this year because I've sat out the pre-existing condition exemption in the first year). But I'm fairly sure the intention behind paying 80% of specialist visits isn't to fund therapy twice weekly! I'll put in a claim and we will see... But yeah I do feel a bit bad about him seeing me for less. But if he didn't agree to do that... Then I couldn't see him (or anyone) at all.

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On the very 1st appt. I had with T, he explained that he had a sliding fee scale, and asked me what I wanted the fee to be. I was so embarassed and couldn't decide on anything because I felt horrible. I felt like no matter what I settled on would be way less than he really should be getting. So I kept saying, "Well, what do you suggest? Don't you have a base fee?" And he would ask, "Well what are you comfortable with paying?" And it just kept going round and round because I felt like such an idiot. I ended up choosing a fee which at the time was too steep for me because I had just started working after five months of being unemployed. I have kept the fee the same, and now it's fine for me, but at the time I struggled and didn't want to admit it to him because I felt so bad.

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pinksoil said:
On the very 1st appt. I had with T, he explained that he had a sliding fee scale, and asked me what I wanted the fee to be. I was so embarassed and couldn't decide on anything because I felt horrible. I felt like no matter what I settled on would be way less than he really should be getting. So I kept saying, "Well, what do you suggest? Don't you have a base fee?" And he would ask, "Well what are you comfortable with paying?" And it just kept going round and round.

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Wow, that actually seems harsh to me. I think I would have been upset by that. I never discussed the fee at all. I figured I could pay whatever he charged me the first couple of sessions and then I'd decide (after looking at the bill) whether it was worth it to me and whether I could afford it. I did know a general price range for therapists in the area where I live so I wasn't totally shocked. But I would have freaked if he'd asked me to name what I was comfortable paying. Actually I think I would have been scared off by that therapist, but I'm a wuss when it comes to discussing money at all. That's a frightening approach!

Sidony

Do you mind if I ask... If this issue might have something to do with your anger?

I'm asking about that because it sounds like you really need to talk to your therapist about this. But this is a really hard issue. So I'm wondering if the anger might be part of an avoidance strategy or something like that. (Please just ignore that if it doesn't resonate, but it is something to think about, perhaps).

I had a similar thing with my therapist on the first session. He asked me how much I could afford to pay. I had no idea what to say. I really couldn't afford very much, but I also didn't want to devalue him by saying a low amount. I think I kind of blushed and hung my head. He said that it could be as little as $5 per session if that was all I could afford.

Before I saw him I asked on a forum what percentage of a persons income people thought was appropriate to pay for therapy. Different people thought different percentages were appropriate. Some people said that their entire salary went to their analyst and they thought it was the best investment they ever made. Of course their husbands salaries were being used to support their family and their lifestyle outside therapy. I don't know how I feel about that... I react to it rather, but I can't name the feeling. Horror? Perhaps...

Basically, I didn't really get a satisfactory answer (in myself, I mean). I realised that even to talk about percentages of your salary is hard. I mean if you are earning a great deal of money then you might well be able to devote half your salary to therapy and still be able to support a lifestyle with designer clothes and the like. If you aren't earning very much then half your salary might be going on rent and basics and that other half... Might well be going on that too.

So, even looking at percentages of salary isn't so helpful.

I am giving him $5 per session. And I do feel bad about that, yeah. I feel bad about that when I buy coffee and when I go to the movies and when I go out drinking. I feel pretty bad about money more generally, however. Have issues around money. I'm so glad he didn't make me come up with a figure because even though I thought about it hard for a couple weeks I had no idea what to say.

Can you think of a figure that would be better for you? I know this is a really hard issue.

Wow wow wow. I am finding this conversation illuminating. And it's making me feel like a bit of a chump for paying full fee. With my first counselor, her fee was $90 per session. She did not tell me that there was a sliding scale. However, my insurance covered 90% of the fee, so I only paid her $9 each time, which was very affordable. With my next T, he stated straight out his fee and again, he presented no option of paying less. His fee was more than hers, and my insurance covers ZERO % of it. So I pay his full fee out of pocket each time. It never occurred to me that these providers would charge people less than their fee. I just assumed if you can't pay the fee, you can't get therapy. Any more chumps out there like me?

pinksoil, did your pizza ever arrive?

When I first saw my therapist, he told me that he wanted to see me every week. I had no idea people went to therapy every week! (It was my first time in therapy.) So I said something to the effect that I wasn't sure I could afford it. And he said that he hoped I would talk with him if that was the case. But after meeting with him a couple of times, I knew I wanted to go and that I could manage to pay his fees. So I never mentioned it again. But I liked knowing that if I suddenly had financial difficulties I could talk to him. I expect a lot of therapists would try to make some kind of arrangements based on need. But I expect they wouldn't suggest it up-front.

Sid

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alexandra_k said:
And I do feel bad about that, yeah. I feel bad about that when I buy coffee and when I go to the movies and when I go out drinking.

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But I would imagine you could occasionally pay him more if you suddenly had some temporary disposable money -- and just say that it could only be temporary before you went back to your usual fee. Then you might not feel as bad (?). Just a thought. Money's definitely a hard issue to bring up though.

Sidony

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sunrise said:
And it's making me feel like a bit of a chump for paying full fee.

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There's no reason to feel that way if you find it valuable!!!

But if it's too financially difficult, talk to your therapist about it. I suspect they don't ALL offer sliding scales or reduced rates, but some of them probably do.

I could save money by going to a therapist within my insurance network, but I'm so happy with the therapist I found I could never change.

Sidony

Not all therapists offer sliding scales. Are you having financial difficulty with paying the current amount? If you are then it would be worth raising this with your therapist. If you are not then you aren't a chump for paying the full fee.

I was a bit worried about how my post sounded...

I guess that to clarify things a little (I hope I'm not rationalising) I'm living on a scholarship which is (objectively) considered to be manageable with respect to basic needs. And it is manageable with respect to basic needs. With respect to drinking and coffee and the like a lot of that is socialisation within the department. We are expected to do this because we are meant to network with visitors and the like.

He offered me the sliding scale once he realised I was living off the scholarship and had no other personal funds (a lot of students have additional funds because of inheritance or top-up scholarship or whatever).

Like I said, I know people who spend their whole salary on analysis. I'm talking a considerable amount of money (full time professionals).

With respect to your thought that if people couldn't afford it then they just wouldn't be able to get therapy that quite often is the case. I have seen a number of people who refused to see me if I couldn't pay the full fee. I've also contacted a number of people who had a student discounted rate that they could offer me but it was still not feasible for me and they refused to offer further discount.

> I would imagine you could occasionally pay him more if you suddenly had some temporary disposable money

Yeah, I have been thinking about that. That is a good idea.

I think it's considered a boundary crossing when the T waives or lowers his fee for a client, isn't it? Not a violation, but just a crossing. I think I remember reading that. Another example of a boundary crossing is when the T extends your session past its scheduled ending time. So the "crossings" aren't too serious, I guess, but interesting to me just how common the "reduced or waived fee" crossings are among the gang here in the PT forum.

alexandra, my financial difficulty paying the fee is that my husband would hit the roof if he knew how much I was paying out of pocket for therapy. He's very controlling about our money, even though we both work and contribute to the bank account. So yes, it is hard for me to come up with the cash each week. But it's not because there's not enough in our bank account. Just one of the many things I'm working on in therapy....

Reading this thread has really opened my eyes to how much I desperately need to talk to my T about my financial situation and how much I am paying for therapy. It is taking up a large portion of my monthly income and I am falling so behind on a number of my other financial committments but again I am soooo afraid to say anything. Talking about money has always been a fear. I even still have a hard time paying him at the end of sessions. He is good where I don't have to pay him after each session and he waits until I get paid to pay for a whole bunch of sessions but it still makes me uncomfortable. He is the first T that I have saw where I had to pay at all. My insurance has run out for the year already (only 10 sessions per year) and I honestly don't see myself lasting at 2 sessions per week for long. Due to what we are working on in my sessions I need the 2 appts. per week but I can't afford it. Any suggestions on how to start the topic off with him?

Thanks

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sunrise said:
Wow wow wow. I am finding this conversation illuminating. And it's making me feel like a bit of a chump for paying full fee. With my first counselor, her fee was $90 per session. She did not tell me that there was a sliding scale. However, my insurance covered 90% of the fee, so I only paid her $9 each time, which was very affordable. With my next T, he stated straight out his fee and again, he presented no option of paying less. His fee was more than hers, and my insurance covers ZERO % of it. So I pay his full fee out of pocket each time. It never occurred to me that these providers would charge people less than their fee. I just assumed if you can't pay the fee, you can't get therapy. Any more chumps out there like me?

pinksoil, did your pizza ever arrive?

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Ok, first things first. My pizza last night: I waited an hour and fifteen minutes and then I called the place. When I had originally ordered, I told them my address and let them know that my street is between 11th and 12th streets. The guy ended up trying to deliver the pizza to 13th street. The name of my street sort of sounds like 13th, but.... if he was listening to me in the first place.... IS 13 BETWEEN 11 AND 12?? So then I had to wait an extra 40 minutes. Finally, after a total of 2 hours, my pizza arrives. Now, I had been really excited because I am a native New Yorker (now I'm in Philly) and there's no pizza like NY pizza. But I'd heard this place was great because they make a thin crust pizza. So I figured it would be worth the wait. It was the worst pizza I ever had.

Now on to less important things like therapy. haha... As far as my fee, I just want to clear it up that I know my T didn't mean to stress me out the 1st session... All of the Ts at the place that I go to work on a sliding scale... So I know he was just trying to let me decide what I felt comfortable paying... But it was still really hard. Anyway, the fee I had picked was a struggle for me at the time. And I know I should have said something because I KNOW he would have worked with me. But of course I didn't! The fee hasn't changed, but my financial situation is better than it was a year and a half ago, so it's not a problem now. And Sunrise, don't feel like a chump. I have paid out of pocket for Ts in the past. You were assuming what's normal-- if you don't have the money for something, you can't get it.

My insurance will only cover 30 visits a year and I have a co-pay of $15 each visit. So T and I split up the sessions to come out evenly over the year. One month it's 2 visits. The next it's 3, and it flips back and forth like that through out the year.

The clinic I go to has a sliding scale and for the longest time I only paid $11 a session. Dr. visits were $25. I now have medicare/medicaid and so I don't have to pay. But I found out my medicaid will run out in April and I can't reapply until I have built up some more doctor bills. I see my T twice a week if at all possible. This week its only once but its cuz my schedule doesn't mesh with his. We have started to schedule 2 weeks at time so I can get in to see him twice a week. I also am on daily contact with him until I can get myself up out of this hump.

I have had T's that I've had to pay full amount for cuz my insurance didn't cover them. Walmart insurance doesn't pay much for mental health. Funny cuz they cause a lot of the problems lol. When I get back into the work force I will have to figure out away to pay cuz the insurance will go back to 50%. I have had one T that sucked so he still hasn't gotten paid. I dont' intend to pay him.

Jbug

I see my T once a week. In the beginning of the year it is difficult to pay as I have to reach my deductible before it kicks in. Once I reach it the price drastically drops and it is affordable. I have 50 visits a year so it lasts pretty much the year. My T doesn't expect me to pay the full fee at once when I haven't meet my deductible I just keep making regular payments until it is paid - also he knows that my insurance will kick in and I will be able to get caught up then.

I noticed when I was looking for a T that there weren't hardly any that had a sliding scale. I feel really lucky that he lets me make payments. I don't know what I would do if he didn't.

I started with every two weeks and have bumped up to every week with my t. I have a large deductible so that hurts. My isurance only pays for 22 visits, so not sure what we're gonna do as I'll hit that quickly going weekly.

My pdoc, every couple of weeks or so, by phone only for about 15 minutes......

Only about every 2 weeks ...

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sunrise said:
One thing I do have a bit of trouble accepting is that T and I have a "real" relationship. I don't feel we do. But he says that what we have is "real." It doesn't feel real to me because I pay him to have this relationship with me. He is doing it because he is paid and it is his job. It isn't truly authentic or real because of the payment/job aspect. It's like he isn't engaging with me because he wants to of his own free will, but because I am forking over the cash. But yet, I do feel warmth and affection and love toward him, and I feel the warmth and affection he projects to me. But yet it is not real. He is paid. I have bigtime problems with this paradox.

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Along these lines, I read a therapist's view on this issue in a book I am reading called Their Finest Hour: Master Therapists Share Their Greatest Success Stories, in which therapist Jeffrey Kottler says this about receiving payment:

"For me, money issues have always gotten in the way. There is something about being paid for helping others that pollutes the purity of the experience. The greatest pleasure (for me) involves making a difference in someone's life when there is only intrinsic satisfaction."

I found it really interesting to read a therapist's view on this.

It's an interesting book all around. I've only read the first two case studies, but they've already given me much to think about.

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One thing I do have a bit of trouble accepting is that T and I have a "real" relationship. I don't feel we do. But he says that what we have is "real." It doesn't feel real to me because I pay him to have this relationship with me. He is doing it because he is paid and it is his job. It isn't truly authentic or real because of the payment/job aspect. It's like he isn't engaging with me because he wants to of his own free will, but because I am forking over the cash. But yet, I do feel warmth and affection and love toward him, and I feel the warmth and affection he projects to me. But yet it is not real. He is paid. I have bigtime problems with this paradox.

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I'll have to check out the book that's suggested, but I wanted to chime in here. I do see it as a real relationship. The money just takes the place of the usual return. In a normal relationship, it's all give and take -- they help you with your problems, you help them with theirs. With the therapist relationship, I'm not helping him at all, I'm only taking his help. Therefore, the money is my contribution in place of the "give" for a give and take. So it's still a give & take relationship, and it feels totally authentic to me-- just different than any other relationship. This leaves me free to feel for him. :-)

Sidony

I've been reading about the financial strain a lot of you have in regards to therapy. My therapist was out of network, but I called in & got authorization for her to be considered in network. The ins. co. had only 2 therapists in network in my area (both males) so I explained I needed to go to a female therapist & they gave me an authorization # for her & said I had 30 visits on the letter they sent. I called them again about having only 30 visits & they said after the 30 visits all the therapist needs to do is write up a treatment plan & say that more visits are necessary then the ins. co. would cover them.

The same thing happened with my pdoc. (out of ntework). I got authorization to see her, too, for meds. They allow one visit a month for that. I sometimes go more often, if I'm having trouble, but I had been to the point of seeing her every 6 mos.

I don't know if this is helpful to anyone. Maybe don't just take what they give you--fight to get the care you need by the therapist or pdoc that works best for you.--Suzy