[mindmechanic]

In an earlier thread, I shared about the therapist temporarily moving to another state for one year. She is a grandmother to a premature baby, and without telling me much of anything, "the situation changed," so she is temporarily moving for a year.

She said that legally and because of her malpractice insurance, I would have to see someone in-person in addition to continuing our therapy relationship and work through phone and video call. I don't have insurance and am paying her 25 dollars each session and see her 3 times a week. She said that she found another therapist who she thinks is a good match with me, but said that most therapists don't accept 25 dollars and that even most non-profit clinics now start at 50 dollars. The therapist said that I need to sort out my money situation. I'm feeling very bitter and resentful about it.

Something came up in her personal life and is now causing a ripple effect in my therapy work and finances, et cetera. And I'm simply told to figure out my finances. I still want to continue doing a single and a double with the therapist, but how do I pay another therapist on top of that? I know that the therapist is already charging me a low fee for therapy, but given that this is something that came up in her personal life, shouldn't she be making reasonable accommodations to make continuation of our work affordable and possible?

I can't simply throw away our therapy relationship. We do psychodynamic and analytic work; it's not like CBT where you can just start over with another therapist.

And I feel like I need more information as to why the therapist is temporarily moving. "The situation changed." - What changed? It's too ambiguous and uncertain; it doesn't give me a clear enough picture. Previously, she said that she'd give her patients one year notice if she moves to that other state. But now this is one month's notice for a temporary one-year move. And what if during her year long stay, she decides to make a complete move? She said that she has the intention of coming back, but how can I trust her now? When I prompted her about what changed and what prompted the movie, she said it's too much personal information. I think it's only fair that I'm given a better picture; otherwise, all of it seems so uncertain like it's all up in the air.

I'm feeling bitter and resentful about all of this. The therapist and I had everything wired up and going well. And her having to move for her child or grandchild is causing such a ripple effect - and I'm sure not only on me, but other patients as well.

i'm so sorry this is happening, mindmechanic. the worst ruptures i've had with my t have been because of money/finances. i find it very very unhelpful when for example she tells me that i need to 'make more money' or 'use credit cards'. i understand how you feel to be told to sort out your money situation. i mean cripes!!

i wish i knew what to say to help you feel better about it all.

[mindmechanic]

I just feel so bitter and resentful that things - not in my life, but hers - are interfering so much with our work. I've put in a lot of time and effort and invested a lot in our therapy work together; I've come so far and everything was going well. However, because she has to make the move to help her daughter out with the baby, it's causing such a ripple effect in my life. Where's the consolation in all of this? Shouldn't the therapist be lowering her - already low - fees to accommodate me so I can meet the "legal requirement" of seeing someone in-person? Why am I paying for the consequences of personal things going on in her personal life?

[Fuzzybear]

I’m sorry this is happening mindmechanic. Finances were an issue with a long term t for me too (it sucks) and as for t moving away... this must be extremely unsettling. It absolutely stinks to have to even contemplate starting over again with another therapist, having put in so much work in therapy.

[feralkittymom]

Why are you continuing with her via phone while she's away? It's understandable that her malpractice insurance won't cover her from another state, and most won't cover therapy by phone. Is she even licensed in the state where she'll be? If not, she technically shouldn't be practicing at all. So I doubt she is considering whatever arrangement she will have with you as therapy (because I don't see how she gets past the licensing issue, and I don't understand at all how she thinks she can continue to charge you, either--seems ethically slippery). Although disruptive, it may make more sense to only see someone locally for the year, and then choose (or not) to resume with her when she returns. That would help you financially, and put you in a more stable situation if life does change and she makes a decision not to return. Maybe she would be willing to continue some sort of contact for the year, but not at the level of therapy.

While it's understandable that you feel aggrieved and deserving of a fuller explanation, she has explained as much as you, as a client, are owed. You can be angry about that, but it doesn't change anything. And it's clearly not going to influence her decision. I don't think she's being honest about her practice and your work by trying to move for a year, yet keep her practice active. It seems as though having you see someone locally, too, is a way of her covering herself malpractice-wise. It really does sound unethical to me, even if it meets her obligation legally.

[mindmechanic]

@feralkittymom: The therapist has a MD license in the state that she is moving to. The thought of starting all over with another therapist is too much.

And how did she decide to go away for a year? That's quite a long time. I can understand moving for three months or over the summer, but making such a huge commitment to move for one year? She said that she has the intention of returning. She said that she wouldn't even be taking on new patients in that state she is moving to. But who knows what will happen over there during that one year? Maybe she decides to move for good. I'm also angry at the people in her life that's causing her to make the move. She also said that she will be back four times during the twelve months for one week each time. Is that the only consolation? Thanks!

[Amyjay]

Oh boy. I can understand your anger and your confusion about all of this.
At the end of the day though she really doesn't have to reduce her fees or give you more information or anything. At the same time I doubt very much that she is withholding anything from you on purpose. This is real life, there is no master plan, things change, things shift and what we think is secure and unchangeable can be gone in an instant. Nobody can guarantee anything.

Of course you feel angry. Of course you feel abandoned. Of course you feel she "should" do more/charge more/tell you more/share more etc. What is happening is beyond your control and it sucks in so many ways. Of course you have questions. for better or worse you don't even get a say in how she answers them. There is so much to be angry about in this situation.

Your T is one of your main sources of support and she is not going to be available in the same way for quite some time. How can you take control over finding yourself some support in the mean time?

[mindmechanic]

I have a question for all of you. Given that this is happening because of something happening in the therapist's life, shouldn't the therapist be making reasonable accommodations to ensure that the patient can still financially afford therapy instead of telling the patient to figure it out? I think that regardless of whether a patient is on a sliding scale or not, if something like that happens in the therapist's life, then it's on the shoulders of the therapist's to make reasonable financial accommodations.

What do you guys think about that? Forget about how it's still less expensive for me to see her because I'm paying her 25 dollars for each session. Few to no other therapist would take that. And the 25 dollars was set by the clinic she previously worked at. She kept that fee when she switched to private practice. My thinking that it's simply a principle. Something happened in the therapist's life. It's changing the trajectory of the patient's therapeutic work. So the therapist has to be the one who makes the accommodations. It's not the patient's responsibility. Why the heck am I paying for the consequences of things that happened in her personal life? How is that on the shoulders of the patient? Shouldn't it be on the shoulders of the therapist from where and whom the change and problem originated?

@Amyjay: I'm not sure. I'm schizoid, an introvert, and have social anxiety. The therapist is my main support. I have friends who I communicate through text, but we don't hang out. Everyone is just so busy these days, it seems.

[WarmFuzzySocks]

mm, I think I’m a little confused.

It seems to me that both your finances and the willingness of a new therapist to accept a particular fee are factors out of your t’s control, so I am curious what specific reasonable financial accommodations are you expecting or hoping for your therapist to make?

I’m sorry this is so distressing for you.

[stopdog]

I am sorry this is happening to you. I do not believe a therapist has any obligation as to fees other therapists charge. I don't see it as being upon a therapist to make sure there are reasonable financial accommodations for a client.

[mindmechanic]

I agree that the therapist isn't responsible for how much the other therapist would charge. But I would think that the therapist should at least lower the fees that I'm paying her each session so that I can afford to see the other therapist in-person. Is that unreasonable? It seems fair, just, and reasonable to me. After all, this originates from the therapist's personal life. She makes the accommodations. Not put it on me as the patient to go and figure it all out. I understand that this is a professional relationship and all that, but I mean, come on. We still have to be fair. If I'm a therapist, I would be making reasonable accommodations for my patient if the whole change and issue originate from me and my personal life. I wouldn't put it on the shoulders of my patient.

@WarmFuzzySocks: I have to see a therapist in-person if I want to continue doing therapy with the current therapist through phone or video call. She mentioned the legal side of things as well as how her malpractice insurance and how it's more of a liability on her part should something happen when I'm in a dark place. I don't want to start all over again with a new therapist; I wouldn't do that. That's why I agreed to her "condition."

[Amyjay]

Originally Posted by mindmechanic

I have a question for all of you. Given that this is happening because of something happening in the therapist's life, shouldn't the therapist be making reasonable accommodations to ensure that the patient can still financially afford therapy instead of telling the patient to figure it out? I think that regardless of whether a patient is on a sliding scale or not, if something like that happens in the therapist's life, then it's on the shoulders of the therapist's to make reasonable financial accommodations.

No. The therapist has no financial obligation or personal responsibility to you beyond each individual agreed upon session. The therapist is free to leave, change or quit practise entirely at any time without needing to compensate clients.

It sounds like you are saying the t should finance your therapy or give you therapy for free because she is moving. Can you imagine any other occupation where this would happen?

To think of it in a different way lets say your dentist knows you are struggling financially and offers you some necessary treatment pro bono or at a greatly reduced rate. Your dentist then needs to move state for family reasons that he doesn't disclose to you. Your dental work isn't finished. He says you can travel to his new practise and he will continue to see you at the reduced rate there. You would like to but you can't afford to pay for the travel costs as well as the reduced fee.

Should the dentist either pay for your travel costs or perform the dental treatment for free so you can still afford it, since he is the one that moved?

Originally Posted by mindmechanic

Something happened in the therapist's life. It's changing the trajectory of the patient's therapeutic work.

Yes. SOmething happened in her life and it has changed the contractual relationship between the two of you.

Originally Posted by mindmechanic

So the therapist has to be the one who makes the accommodations.

No. Her circumstances have changed. She has told you the previous "terms" aren't going to work for her anymore (because she won't be here). New agreed upon terms have to be decided upon. She has offered you some. She isn't being heartless. She isn't throwing you under the bus. She needs to be with her family. She is offering for you to still have contact with her. It won't be the same. Not nearly the same. And she wants you to have support face to face during that time as well.

Originally Posted by mindmechanic

It's not the patient's responsibility. Why the heck am I paying for the consequences of things that happened in her personal life? How is that on the shoulders of the patient? Shouldn't it be on the shoulders of the therapist from where and whom the change and problem originated?

Her obligation to you doesn't extend that far. As a human being she is committed to her family. They will likely always come first, as it should for every person. Family should always come before work. Even if it is emotional and relational work like therapy. But that doesn't mean she doesn't care about you or feel some responsibility towards you. (But she is not financially responsible to or for you, that is your responsibility no matter what.)

[Amyjay]

Originally Posted by mindmechanic

But I would think that the therapist should at least lower the fees that I'm paying her each session so that I can afford to see the other therapist in-person. Is that unreasonable?

I do think that is unreasonable.

[mindmechanic]

@Amyjay: Harsh words. But logical. I'm thinking about your dentist analogy. It makes sense; thank you for coming up with that analogy. But something in me still isn't sitting well with the situation. I'm still feeling resentful about it; there seems to be something different about the dentist situation versus the therapy situation. I can't seem to pick up on the distinction, though.

Family coming first is something that I don't understand. I do not even understand the notion of what a family is. To me, everyone is on equal footing. If a family member and friend, acquaintance, or patient is in need of help or guidance at the same time, I would help according to the urgency of the presenting situation or problem.

[Amyjay]

The distinction is the emotional and relational aspect I think. We don't expect our dentists to care for us. but we expect our therapists to understand and feel some emotional obligation to us at least.
Your feelings aren't wrong at all. I know I would feel the same way in the same situation. It really is awful and I am so sorry this has happened. Emotionally I totally get that sense that your T IS somehow responsible because she cares about you and you guys have this relationship that is REAL.
It's a hard situation because both sides are "right" but they are opposites so its hard for us to wrap our brains around.
In the therapy relationship our therapist really DO have a duty of care towards us.
AND the therapist actually doesn't have a duty of (financial) care for us (or the therapists family takes precedence over us or whatever).
But both things are true. The fact that she truly and reasonably doesn't owe you financial responsibilty in the circumstances does not negate the emotional and relational bond you have in your therapy.
I think its just one of those cases where opposing realities actually both are true even though logically it doesn't seem right.
Your feelings are justified. They are real.
Even though in this case she really isn't responsibile.

[Amyjay]

Originally Posted by mindmechanic

If a family member and friend, acquaintance, or patient is in need of help or guidance at the same time, I would help according to the urgency of the presenting situation or problem.

It really sounds like there is a genuine problem in her family and that she is truly needed.

Your resentment makes total sense. Because of this issue with her family YOU miss out. Who wouldn't be resentful?

[mindmechanic]

@Amyjay: I think that you're hitting the right points. I need some time to think about it. I agree that it's a professional relationship that involves monetary transaction. You're right; I wouldn't expect the dentist to pay for my travel cost, but in the case of therapy, I expect the therapist to make the accommodations given that the problem originates from her. It's such a harsh reality. Something happened in the therapist's personal life, our work together that was going well is now off to another trajectory, and I have a load of burden on my shoulders now. I'm feeling so resentful; I have enough on my plate, and that one place that should be safe and consistent, and where I seek help is now causing a whole lot of problems for me.

About the financial part, I still think that people should have a heart in what they do. Can't she go any lower so I can use that money to pay the other therapist who I would see in-person? I need some time to think about this. I agree with you that the therapist isn't financially responsible for me. But I do feel that she owes me something in this situation and given the context in which it's happening.

[mindmechanic]

Is she truly needed? Is it a life or death situation? Of all grandparents and family members, why does it have to be her? And how did she decide on going away for one year? That is a huge commitment.

I keep on having feelings of dread creep in every so often. I need some more information because telling me that "the situation changed" and "I'll be temporarily moving to xxxxxx for one year" is too ambiguous. What changed? The baby's situation changed? The parents' situation changed? The therapist's heart changed? I feel that knowing the primary motivating reason for her making the move would give me insight into the odds of her returning or her plans changing again to where she decides to make a complete move.

And I don't mean this in a psychopathic or sadistic way, but I want the therapist to hurt like I do right now. That woman, at the very least, owes me this. I'm so resentful and bitter now.

[Amyjay]

I hear you. It really sucks. I'm sorry this is happening.

[*Laurie*]

I would feel insanely resentful and bitter, too. And it is disgusting, deplorable, that care for people and animals is, bottom line, all about money.

So. I completely understand your resentfulness and bitterness. I also understand that the reality is, your therapist has a family and has to prioritize her own family over the needs of her patients. She is not a nun or one who martyrs herself for others; she is a person with a new grandchild and she wants to, or needs to, be involved in that child's life.

It would be natural for you to feel envious of her family, too. Perhaps you wish you were her "real" family. If you do, I don't blame you one bit.


I am so sorry that you're going through this. But go through it you will. Your future with regard to therapy will continue in some way.

[Myrto]

Sorry I'm going to be blunt but what you want is completely unreasonable. Your therapist is moving to help her daughter with her grandchild. What did you expect exactly? That you're such a precious client that she wasn't going to move? You're a client. Of course her family matters more than her clients, it's the case for everybody. As for the financial issues of having to pay another therapist, I don't see why it would be her responsability to ensure you pay a lower fee. If you can't afford therapy, you could go less often. I don't tend to defend therapists but in this case, you sound so entitled that it's making me defend them.

Eh, when the session fee doubled without any notice, every patient at the public health clinic I'm in was just told to suck it up. Sadly those who couldn't afford the new fees had to space out sessions, and I'm sure some stopped going. Universal healthcare country.

I pay $200 a session for my sibling who's a minor. We can only afford to go once a month and his therapist's full fee is $300.

$25 is a steal, heck $50 is a steal. I understand cutting down from 3x a week is difficult. However this is a business for them, a service provided. If we can't pay, we can't see T.

Video calls and phone calls when she's in the new state? That's incredibly generous. Plus sessions when she travels back to your state? She doesn't have to do all this you know? She can simply just...refer everyone to other therapists and not even "continue the work".

We're their job, as much as someone (like me) would wish otherwise.

[feralkittymom]

In a very real way, how is this situation any different from your issues about the office being too noisy? You resented your therapist's refusal to give that issue the same level of importance as you accorded it. You wanted her to take responsibility for the conditions and fix it for you. And you seemed outraged that she wouldn't accommodate you. Do you emotionally relate to her as a mother and yourself as an infant whom she is obligated to take total care of? I understand how that dynamic can come about, and how strong such feelings could be, but the truth is that dynamic can never be realized. Continuing to invest so much emotional energy in unavailable remedies feeds frustration. Is there a way you can reframe your needs in ways that can be met? Some compromise?

[mindmechanic]

I think that you guys are right in that the therapist is not responsible for making any financial accommodations. It just feels that she, at the very least, owes me that because our therapy trajectory has now changed - because of her. For me, this is a huge setback.

@QuietMind: I don't know why the therapist offered all her patients to continue therapy with her through phone or video call. You say that that is incredible generous. Well; perhaps the reason for her continuing to work while away is that she still needs an income - some way of making money during the year. She also has a full-time contract with a university, and she said that the university will be making accommodations for her to continue working and doing research while she is out-of-state for the year. Does she care about her patients? Are we just "cases" or "projects" to her? Does she see us as human beings with real feelings? It's all sunshine and rainbow with pretty, fresh-scented flowers, and unicorns dancing in the clouds all around her for the year ahead. She gets to be with family while also getting paid as she continues her work and research. Who feels the burn in all of this? Her therapy patients.

And @Myrto: I sound so entitled? If you've came to trust someone and invested a lot of time, effort, and energy into something that basically concerns your life, and all of that is at risk of being jeopardized, tell me how the heck would you feel?

@feralkittymom: Perhaps your analysis is correct. But I think that there are some things that therapists, in general, should do to ensure that the therapy space is as conducive as possible. The therapist and I talked about the noise in the room. I accept what she said about the noise being standard for most therapy rooms in the city. On the other hand, I said that some effort still have to be in place to ensure privacy and also disruptions from along the hallway. This is the least that therapists should and can do to ensure the space is conducive. Most therapy suites or rooms have a white noise machine. The suite that she was in didn't have one; the previous one that we were using had one. Just yesterday, there was a child patient crawling back and forth along the hallway while the child's therapist was interacting with that child. There also isn't a sign on the door that says vacant or session-in-progress, so when we have our meetings in the evening, the cleaning person would always knock on the door, interrupting the process.

Making a commitment to leave for one year is huge. Perhaps she doesn't realize it yet but her heart is in that other state where her adult children moved to and now live in. Why don't she just make a permanent move. Moving away for a year is a huge commitment to make right off the bat. Three months over the summer or six months - I can understand. But a year? Just make a permanent move; get the heck out of here.

[feralkittymom]

^These are details I don't remember you mentioning in that thread, and should have been remedied. But the issue really isn't in the particulars: it's your basic feeling that you are being treated unfairly, and that it must not occur. If you've been working analytically, the theory of infant anger is familiar. Life is full of unfairnesses, but that's its nature. I've found that "shoulds" in life have correlated with degrees of frustration: the more I can abandon the idea of "what should be," the less frustration I experience. It has little really to do with the "shoulds" but more to do with seeing myself as someone who can step out of the way, or move around, or compromise, or define a different path that allows me to feel in control--or accept my lack of control, ultimately (not sure anyone except the Dalai Lama can get there 100%!)

But I think you're also exaggerating the rosiness of her changing circumstances in order to feed your resentment. Moving is an upheaval and not much fun for most people. She is getting time away from her University because that structure exists, but it isn't without a trade-off: most Univ allow for a sabbatical once every 6 years with 1/2 pay for a year or full pay for a semester. A leave of absence often comes with no pay. Her return trips may also be to satisfy some Univ requirement, as well as check in with clients. And daily care of a special needs child can be stressful.


Some of the feeling of resentment is a natural reaction, but you have a choice whether or not to magnify it by how you define the situation you find yourself in.

ETA: So she can't do anything that is acceptable to you. She must act only on your terms and have no independent reality apart from you. That's an infant's world view.