[Eleny]

Hi, I'm looking for some advice on a therapist I am thinking of returning to.

I saw her before for a year and she did amazing work with me, I saw a huge change in myself after a year. However, there were a few red flags that came up. When I had severe health anxiety I was referred to a psychiatrist and she seemed annoyed at me and seemed to disagree with my choice to do that, even though it ended up helping me immensely.

I told her once I couldn't come the following week due to not having enough money and she went very silent and looked very disappointed until I gave in and said ok, I would figure out the money and come next week. She told me I had to be consistent with my appointments as it was really important, but I still found her reaction odd. Finally, when I had to terminate therapy (again for financial reasons), I told her I had no money but could I come for a closing session. She said no, I could come back when I had money. This was incredibly upsetting and traumatic for me and I couldn't even think about it for the next few months without breaking down. When I had money again I went back to her, but I had lost all trust in her and felt very closed up.

In the past few years I've had a few different therapists here and there but it's so difficult to find the right one. Lately I've been thinking about going back to this T as I found her so good. There were some red flags for sure, but I learned so much from her and she helped me immensely with developing self awareness and inner confidence. But maybe it's a step backwards at this stage and I may find myself closed up again.

What would you do?

[DP_2017]

If you feel you can get past those things, sure why not? It's been a long time

I am not sure how I'd feel, reading it, I got a "only about the money" vibe from her which bugs me... BUT maybe I'm not reading her right. Only you know her and know yourself. I guess it can't hurt to try, maybe go once and see how it feels after?

"looked" "seemed"
Maybe double check that's what's really going on.
Can't imagine an adult being that childish.

[Rive.]

Personally, I wouldn't see her.

You say she's been helpful and so good but this (the bolded part) concerns me: "When I had money again I went back to her, but I had lost all trust in her and felt very closed up". Could you still work with her under the circumstances? Take that risk with her again?

She may have been useful once but maybe you've outgrown her and it's time to move on.

I wouldn’t see her.

I’ve heard of many therapists willing to work with clients going through a tough time money-wise. Despite my therapist’s flaws, she assured me that she would continue seeing me at a prorated fee if I couldn’t afford her regular fee.

It seems extra cruel not to offer any options when money problems could potentially cause a psychological crisis. The client is stuck with money problems and no help.

[AllHeart]

Disagreed with you on seeing a psychiatrist, which helped you immensely.
Only concerned about money.

She has her best interests in mind. None of yours. So...No. I'd lock the door shut on that one.

[Favorite Jeans]

That’s a really tough one. I would worry about a T who didn’t respect my financial (or any other) boundaries. If you decide to go back to her, maybe it would be worth spending time on this issue upfront and asking for her assurance that she will not pressure you financially. Also maybe ask if she’d ever be willing to have a flexible arrangement where you defer payments or see her less frequently if that ever becomes necessary. Even if the financial situation has changed and money is now no object, I would need to know for sure that she could be trusted to respect my stated limits without pushing.

[growlycat]

That would bother me too. Maybe you are attributing your growth to her when it is YOU that did the work.

Her reaction seems odd unless you had a history of using monetary reasons to pull out of difficult work in therapy. But you don’t come accross that way.

My current t gave me a card when we first decided to work together. It was good for one free session in return I agreed not to ghost on him. Although he did not ask for the second part I offered it in goodwill. If I had financial difficulties I am convinced that my current t would work something out with me. With my old t, we worked something out when I was suddenly unemployed. I paid him eventually.

I would be wary of any t that guilts you into acting a certain way.

[WarmFuzzySocks]

Loss of trust is a pretty big deal. I would likely try to identify the qualities and approach that were helpful, and focus my search on finding a different t with a similar style but without the red flags.

[Parva]

My understanding was that a T is not supposed to terminate you for legitimate financial reasons once the therapeutic relationship has been established. I get that a complete lack of ability to pay anything is one thing, but I thought the T was supposed to re-define the fee scale according to what you are able pay.

I thought this was a pretty standard ethics situation??

[Capacity]

No, absolutely not. I feel like this is something that will always hold you back from trusting her 100%. Keep looking.

[stopdog]

No. I would not.

[SlumberKitty]

I wouldn't.

[Amyjay]

If I had done good work with her in the past I would probably try going back to her.
The money thing doesn't worry me, just because I see the relationship as a transaction. I pay for my therapists time. I would not choose to see my T if she didn't receive her fair dues for the transaction. She owes me absolutely nothing for free.
The psychiatrist thing doesn't bother me. It would be entirely up to me if I went for that or not. My T could approve or disapprove all she wants. I don't pay her for her approval.
The caring is separate. I would want a T that cared, at least somewhat. But caring is separate from the money issue. Ts are not paid to care. They are paid for their time and their knowledge. Caring or not caring is entirely unrelated to the payment for their time, and not seeing you because of you not paying is not evidence of a lack of care, but a lack of equality in the relationship. Clients get their allotted time and their Ts expertise, and the T gets financially compensated for that. That's the equalizer.

I see most people here say they wouldn't go back to your T. So I guess I am in the minority here. But I just couldn't even imagine expecting T to see me for free. I just couldn't do it. I most certainly wouldn't ask, and I don't think I could bring myself to accept it should it be offered.

[Taylor27]

I would never go back she should of been supportive of you going to the pyschiatrist and money she seems to put too much importantce on that. hugs

[Wonderfalls]

It seems to be a pattern that people expect your therapist to see you at little or no money when your finances bottom out. Why do you just assume that she can afford to that herself? If her budget is tight she may actually need her whole income, like the rest of do.

[Parva]

Originally Posted by Wonderfalls

It seems to be a pattern that people expect your therapist to see you at little or no money when your finances bottom out. Why do you just assume that she can afford to that herself? If her budget is tight she may actually need her whole income, like the rest of do.

My experience in therapy is limited to childhood trauma, so I can really only speak to that. My sense is that most trauma-based therapists understand that a patients finances will change over time and accept this from the outset. Therapeutic issues like trauma span years and years, and the damage done to a patient by dropping them because they can't pay full price can be immeasurable. I knew an older therapist that retired, but kept seeing her existing patients for years afterwards for this very reason.

I don't think that high trauma patients are trying to exploit the therapist or being selfish or inconsiderate, and my guess is that most of them truly agonize over having to ask the T for a financial break. It goes against everything their abuse taught them about themselves, i.e., they aren't worthy of love and care. A good therapist not only absorbs the financial change, but uses this as a therapeutic tool to help the patient understand his/her value and worthiness of care.

For these T, this is a calling, not a career. It's how they make a living, but I think most of them do it for far deeper reasons.

[Anne2.0]

Originally Posted by Parva

I don't think that high trauma patients are trying to exploit the therapist or being selfish or inconsiderate, and my guess is that most of them truly agonize over having to ask the T for a financial break. It goes against everything their abuse taught them about themselves, i.e., they aren't worthy of love and care. A good therapist not only absorbs the financial change, but uses this as a therapeutic tool to help the patient understand his/her value and worthiness of care.

For these T, this is a calling, not a career. It's how they make a living, but I think most of them do it for far deeper reasons.

As someone who has worked with several therapists related to childhood trauma, I don't believe this is the norm at all, it is not in any ethics code I am aware of, and although I think it's great that some therapists have sliding scales and do work for free (and I relate to that sense of a calling rather than a career, which I'm sure is true for some of them), I'm not sure that this might make sense at all.

I think that giving someone free or reduced therapy might backfire into reducing the client's sense of self value and may make them feel worse about the care that they receive. I'm not sure what it would be expected that long term therapy should result in a negative financial change.

For me, since I wanted long term therapy and still do, I have to make sure that I can afford it. In the early days, keeping my job so I could continue to have good insurance with a small co-pay for sessions. If I was decompensating during therapy and my financial empire was tanking for the long term, I'd wonder if therapy was helping me. Or maybe dealing with trauma was too intense or too fast for right now (at times it has seemed that way to me). I would not stay in therapy where the consequences for my real life-- financial, social, employment, whatever were too great.

I don't think it's responsible-- and you may not be suggesting this-- for a therapist to treat a trauma survivor who walks in the door functional, including being able to pay for therapy, and who is so affected by the therapy that s/he can no longer pay for it. Then the therapist gives it for free, which seems to reinforce the message that s/he is so messed up that s/he needs therapy for free. A better route might be for the therapist to help the client keep or achieve his or her financial goals so the person can live like they want to, including therapy as part of their lifestyle. It feels to me like free or reduced cost therapy could have the opposite effect.

In addition, there are resources in many communities, especially for survivors of trauma. There are free community mental health agencies, there is free counseling for survivors (including free support groups) at Rape Crisis Services and Domestic Violence Shelters (the later almost always do counseling for non-residents of the shelter, and the definition of domestic violence includes all familial relationships and doesn't have to be intimate partner violence. Sometimes these free counselors are able to hook clients up with a higher level of care, if needed, as they have access to other therapists in the community, some (at least in my town) who volunteer to provide free services to survivors who need more than what the organizations can provide.

I wish there were more free and low cost services for mental health. I do understand that not everybody can access them, but I also think that a particular T is not required for progress. I'm sure this is a minority opinion on this board, but for me if a therapist thinks they are the only one who can help me and so they give me therapy for free, I'm going to want to run away from them. This facilitates the sense that it is a therapist, rather than therapy itself, that can help people. And while I believe in a good fit between the therapist and client, it would feel like my therapist was more like a guru if he was required in order for me to make progress.

[Tac0cat]

I think that regardless of how any of our doctors, or counselors, may feel about us at the end of the day it is still a business. How would any of you all feel if people come to your work and want things for free? Are you even approved to give things away for free?

If you liked them, and they helped, then I think you should get past it and go back. Honestly, I think you are letting your emotions dictate your actions. Look at the bigger picture. If they helped you before, then they probably can again. Zoom out and see what your life would be like with them in it again and what it could look like without help.

[growlycat]

If I have a freelance client who tells me they can’t afford to hire you this project I would not guilt trip them because they aren’t being a consistent client. I don’t like therapists that insist that you pay even in THEY go on vacation or if you are taking a vacation.

[Myrto]

I don't have a problem with therapists being paid, frankly I think the transaction aspect is the only honest part of this dishonest business. But if a client can't pay for whatever reason the therapist doesn't get to guilt-trip you into paying for another session you can't afford. What if this is money you're using to pay your rent? or your groceries? This is super gross. You see the therapist when you can afford paying her (or if she has agreed to be paid at a later date) so in that regard I think it's a massive red flag from her.

[Myrto]

Originally Posted by Jessica11

"looked" "seemed"
Maybe double check that's what's really going on.
Can't imagine an adult being that childish.

Because we all know that therapists are all mature human beings, who are totally not petty nor childish. Also nice gaslighting.

Originally Posted by Parva

My understanding was that a T is not supposed to terminate you for legitimate financial reasons once the therapeutic relationship has been established. I get that a complete lack of ability to pay anything is one thing, but I thought the T was supposed to re-define the fee scale according to what you are able pay.

I thought this was a pretty standard ethics situation??

I agree there's ethics around payment in general. It seems odd a therapist couldnt make arrangements for one last session.

Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

Ethical Principles of Psychologists and Code of Conduct

Originally Posted by Parva

My understanding was that a T is not supposed to terminate you for legitimate financial reasons once the therapeutic relationship has been established. I get that a complete lack of ability to pay anything is one thing, but I thought the T was supposed to re-define the fee scale according to what you are able pay.

I thought this was a pretty standard ethics situation??

I agree there's ethics around payment.

Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

But this is enough reason for me to not want to see this T again:

Finally, when I had to terminate therapy (again for financial reasons), I told her I had no money but could I come for a closing session. She said no, I could come back when I had money.

So no, I would not unless I couldn't find another T. If she helped that much, I might weigh the pros and cons before deciding.

[Calilady]

Wow. Tough spot, but I wouldn't go back to that T.