Am I being unreasonable?

Sorry, this is a long one but if you get to the end, I would really appreciate it!

Over the weekend there has been extensive flooding in my city. Literally thousands of homes have been destroyed, roads are cut off and public transport has been cancelled all week. Naturally, I was wondering what would be happening with my therapy session which was today. Given the circumstances, I expected an email from T detailing her plans and making sure I was still able to commit to the session.

Well I waited and waited to hear from her and nothing. There have been cases in the past where she said she would "get back to me" but didn't so I ended up emailing first. This time I thought "let's wait and see how long it takes her". I waited until early afternoon yesterday before I caved and emailed her checking she was okay and asking what the plan was for the session. I didn't get a response for several hours so I texted her too because I was starting to get worried now. Finally, I get a reply 6 hours later saying she had checked the latest advice which was to stay off the roads so we would be doing telehealth.

In session today, I expressed my dissatisfaction with T's lack of communication and she said she wasn't planning on emailing me at all and was just going to go ahead with an in person session as normal. It wasn't until she got my messages that she checked the current advice and decided to do telehealth. I was flabbergasted. I said "how was I supposed to know the session was going ahead if you weren't going to tell me? There are roads cut off, no public transport, homes destroyed and I'm expected to assume everything is going ahead as normal? Seriously??". She was kind of just like "yeah, if you don't hear from me then assume the session is on". I was like don't you think these are extenuating circumstances?

The second part of this conversation is about her cancellation policy. I almost cancelled my session today because my boss had asked me last minute to come into the office. My session is first thing in the morning and I was stressing about the logistics of getting into the office. I decided against cancelling because I can't afford the $200 fee. I've seen this T for almost 3 years now and only cancelled once but was still charged. I brought this up today and T explained she enforces this rule regardless of circumstance. I said that doesn't seem fair especially in these current circumstances of a natural disaster. T said she always tries to arrange a "make up session" but I reminded T that I don't have that sort of flexibility in my work schedule so just have to cop the fee. It just doesn't seem fair at all. This conversation wasn't going anywhere and T just said she didn't want to argue which made me feel like there was no point in me even talking about it anymore even though I am still upset.

There just seems to be no compromise on T's part at all and I have no choice but to go along with it. I am very attached to this T and like her a lot but this hard for me to accept. Do you think I'm overreacting? I'm still so upset by this.

I don't think you are overreacting but

(1) re whether the session on: that has been my experience. If you don't hear from T, then yes, assume the session is on. I would be the one to reach out and check with T (in circumstances you mention) to be sure the session was going ahead. So, if T doesn't cancel, the session is on.

(2) re being charged: again some Ts will charge regardless if you don't give their them the stipulated notice in the contract you both signed before working together. Again, some Ts will apply the boundary regardless of length of time they have known you or whatever circumstances arise.

Your feelings are valid but this is how some Ts operate. It is a business after all and some will apply the 'rules' regardless.

I agree with Rive. Personally this very strict approach for cancellation (or anything really) didn't work for me, so I found a T who was more flexible. Bit even that had it drawbacks. The thing is, sometimes you just have to take the rough with the smooth, as they say. And your Ts lack of communication and cancellation policy are two very rough areas, but you can't change someone else. All you can do is work out whether they are things worth putting up with.

Not sure if you know my story, and don't want to take over your post, but that is why I did not continue with a lady I was seeing. I could see she was a great T in some areas, but there were too many roughs in the wrong areas.

Anyway, all that said, you should stil feel like you are able to discuss these things, in my opinion. Even if you accept you cannot change them, you have a right to talk about your problems with her, and these are problems. Her saying she "doesn't want to get into an argument" is not a great way of holding her boundaries. She should be able to hold them whilst allowing space for your upset and your anger.

I too would be nervous and worried and want to know what is going on, but we aren't all the same...

I hope that you are staying safe out there!

I don't know, considering large parts of the city have been without power, internet and transport I'd expect T to a) reach out to make sure I was able to come in and b) not charge me a cancellation fee if I was unable to attend. I don't care what I signed, it seems extremely unreasonable to charge someone $200 regardless of reason. What if their home was destroyed and they were unable to get in touch more than 24 hours before the session? Does that seem fair? Not to mention this cancellation fee deters people from staying home when they're ill and given that we are still in a pandemic, some flexibility should be allowed here.

This is not the only time I've been at T's every whim. Originally my session was after work as that is what suits me best and T said she could accomodate that. Several months in and T says that time doesn't work for her because she's too tired by the evening. Despite the fact that I have a work meeting every morning that conflicts with the new session time she's offering, I have to disrupt my work schedule to accomodate her needs.

Next thing was when T went on maternity leave and said she would be back after 6 months for in person sessions. She contacts me towards the end of the 6 months saying she's going to do telehealth for a couple of months to ease back in. I asked if we could move the session 30 mins earlier (which would have been my usual session time) and she said she couldn't, explanation given. Once those few months were up, T decides she's not ready to go back to the office so online sessions it is for the rest of the year.

Then at the beginning of this year when she said she was thinking about returning to the office, she said she wasn't 100% sure and would confirm with me before next session. It gets to the day before the session and I still haven't heard from her. I send an email asking and she responds saying she's unwell and we will have to do in person the following week.

This is a pattern of behaviour and whenever I bring it up she "validates" my feelings but shows no interest in changing her behaviour at all. I'm just expected to sit back and accept this "as part of the relationship". I have no control over anything that happens, it's all up to T.

Having seen this T for almost 3 years now, she would have been well aware that I would have been worried and need reassurance. Her not giving that is part of why this is so hurtful. I will be bringing up her comment about not wanting an argument next session because that does not cut it for me. I have had three T's in the past leave me for various reasons and this one has stuck around so that counts for something.

I don't think you're being unreasonable at all. I really don't understand her saying "I don't want to argue". Just like I didn't understand when my now-ex-T not long ago cut me off in the middle of something I was telling her and changed the subject. I was so flabbergasted I just went with it and didn't say anything. I don't think it's right that she stopped you from talking about it even if it was an argument. Cripes. I'm sorry she's being so absolutely rigid about her fee, also.

I agree with Rive that the general assumption is that if you don't hear from her, the session is on as planned. However, I tend to prefer to know sooner than later, like I don't want to want for a possible cancellation from T. So in the past, if, say, it snowed, I'd send him a text asking if session was still on that day, and he'd get back to me quickly and say he'd be in the office. But his default also seems to be that if I don't hear from him, everything is going as planned. Yet he's fine with my checking in. To me, your T taking so long to respond is a bit of an issue and something worth talking to her about. Does she prefer a particular form of communication, for example?

In terms of charging you, that would bother me as well. I definitely think she should have been lenient and not charged a cancellation fee if you couldn't make it to her office due to the flooding. Or if you woke up sick. However, you were potentially going to cancel due to work, not due to the weather conditions, so maybe she would have seen that differently? My T is generally lenient in terms of last-minute cancellations, though one of those times I was in the ER with heart palpitations, and he said of course he wouldn't have charged me for that (I was able to reschedule for the next day). And ex-T didn't charge me when I was sick once.

I think sometimes T's find it easier to just have a set policy that they bill clients no matter what if they cancel at the last minute (or within 24 hours, or whatever their policy is) or just no-show without warning. Then they don't have to make decisions on when to make exceptions. However, I also feel like there should be some flexibility on their part in terms of charging, particularly if it's illness or some sort of family emergency or if it's a rare event, like the client cancels maybe once a year. But again, some T's find it easier and more "fair" if they just have a set policy.

I'm in the "have some leniency" camp. But also consider that if you cancel and your T doesn't find someone to fill your spot, then she's out $200. One time in a year, no big deal. But if she has several clients a week do that, it can really add up. This is assuming that you normally pay her $200/session--if you pay less than that (or use insurance that pays her less, which you couldn't bill if you don't attend), and she's actually making *more* money by your being out, that seems really unfair. The same if she found someone to fill the slot and is then getting paid double.

(I say this from the perspective of someone who works as a freelancer, where I'm not guaranteed a particular salary, it depends on what work I do in a given week.)


I think she should be open to talking about all of this, too, and it sounds like you may need to spend more time discussing it.

It would bother me that she said she didnt know the roads were closed. I would wonder wth is wrong with her.

But - therapy should be teaching you agency, taking care of yourself, so i would take her statements re the flood with a grain of salt. By waiting for her to call, you were waiting for fairy godmother to take care of you. Thats the problem. I guess i would not apply the no-cancel fee to this particular situation. Just look at it more as, why were you sitting on your heels waiting for her? All that matters is YOU here. Its not like she is a school. I think thats why she was being weird. She is just pointing out that nothing changes unless you take action, which you did. So basically you did good.

I think your feelings are your feelings, but I always assume if I don't receive word otherwise that an appointment is on. If I personally can't get to an appointment because of weather, etc., then it is up to me to cancel. If my therapist/doctor, etc. can't get to the appointment, it is on them. But checking in with each and every client if nothing has changed on their end might be a bit unrealistic. (And yes, sometimes one person is able while the other is not). I have had situations where the therapist/doctor had to cancel, and there was a system to let clients know of that issue and how to proceed.

As far as the late fee goes, if that is what was explained when you because a client, that is what was agreed to. Yes, some therapists might make an exception in an emergency, but they aren't obligated to.

It's okay to be upset. I am certain it is quite stressful there right now. I'm just not sure it makes a difference as far as policy goes.

You might not care what you signed but a signed contract is binding, that is the agreement you chose to abide by. Also, it is the treatment provider who sets the conditions for how they work, not the client dictating their conditions to the therapist.

Being angry won't change the way your therapist chooses to work. This is where free will comes into play - if you are not happy with your T's conditions, you are free to go to another therapist.

And it is not a T's responsibility to check whether clients can come. This is about personal agency. The client can reach out to confirm but a it is not a T's job to check whether a client can come to an appointment you both scheduled.

I don’t think you are grasping the gravity of the situation. Literally thousands of people have been without power, internet, road access or public transport. How am I supposed to know T was not one of them? Secondly, how can she just assume I have a way of contacting her and getting to the session? These are extenuating circumstances and I expect a basic level of communication. The fact that she hadn’t even bothered to check the road conditions until I contacted her says it all.

As for the cancellation policy, I expect a bit of flexibility here. Applying the same rule to someone who cancels because “something came up” vs their home has been destroyed by natural disaster is beyond ridiculous. T’s explanation for this lack of flexibility was she had a client years ago claim they were sick but she later found out they weren’t. She also said she wants to keep the relationship between us “clean”. How’s that working for her?

To say I have the option of finding another T just shows your lack of understanding of the significance of the therapeutic relationship. I have invested so much of myself into this T, building trust and overcoming relational traumas. I have also formed a strong attachment to her in this time and to just quit and start with someone else would be extremely traumatic. I rely on this T as my emotional support which again, appoints her more power. I need her more than she needs me and she knows it. Her lack of flexibility takes advantage of this fact.

Well I think it’s fully appalling. I’m totally with you.

If there were a huge disaster here I would find it super weird for T not to verify that I could come in or at a minimum to have thought the issue through. What if you were unable to communicate with her? What if you were suddenly homeless?

I get that some people have really strict policies around paying for cancelled appointments but… we’ve all had to adjust to MANY new things with covid and if AIRLINES now let you cancel last minute without penalty, therapists can find it within them to flexible. Especially for clients who are generally conscientious and respectful of their appointment times.

I guess the question is: can you live with this? Is it a dealbreaker for you?

I really wouldn’t like it. There would have to be a lot in the therapist’s pros column for me to tolerate what you’re describing!

I absolutely wouldn’t see a therapist who charges for cancellations. It must be uncommon in my area as I literally never met or heard of therapists who do that. It wouldn’t work for me

Favorite Jeans - i know, AIRLINES?! That might be the one good thing to come out of the pandemic, not having to pay for cancellations. What were we before, sheep?

I don't think you're being reasonable. I would have also liked notification if a session was not likely to continue in the usual way due to heavy flooding.

This is what stood out for me the most though.

My old T was very much like this. Finding someone else has been so different. I know you're attached but if it's not working for you can find someone else who will let you have input into the "rules".

Charging $200 per hour is the unreasonable bit in all of this. Do these therapists think their words are golden nuggets?

Therapy work is not like other business. It is work which involves our hearts and deepest vulnerabilities. The idea that she would invoke a cancellation clause with such little regard for your circumstances amidst local devastation is distasteful and mercenary. I don't think you are being unreasonable, I think you are hurting.

Quote:

Originally Posted by comrademoomoo Charging $200 per hour is the unreasonable bit in all of this. Do these therapists think their words are golden nuggets? Therapy work is not like other business. It is work which involves our hearts and deepest vulnerabilities. The idea that she would invoke a cancellation clause with such little regard for your circumstances amidst local devastation is distasteful and mercenary. I don't think you are being unreasonable, I think you are hurting.

I agree. My doctor only charges $25 for a missed appointment how is my doctor’s time worth less than this therapist? I understand a therapist has time they value but $200 really?

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The missed appointment fee is meant to cover the cost to the therapist when someone no-shows or cancels so late that the therapist can’t fill their spot. To me it makes sense to charge a client who misses appointments somewhat often with no notice. Some clients are habitually disrespectful of the therapist’s time. Without billing them for it the only options would be to tolerate the income loss (and loss of availability to would-be clients) or to terminate the client. So I think in principle the fee is okay.

It is completely unfair when a generally conscientious client is ill or has a similar emergency, or you know, your area is in the throes of a natural disaster. Every therapist I’ve ever been to has a no-show fee policy but none has charged it when I’ve had to cancel for illness, major family issue or even for the occasional (frontline HCW) work emergency.

I agree with all of this. I feel like the fee can be meant as a deterrent for frequent no-shows or last-minute cancellations. Like, "Eh, I don't feel like going to therapy in an hour," as opposed to a health/family/weather/transportation/work issue.


I also think there's a difference between letting the therapist know as soon as you're able, as opposed to waiting until the last minute. Basically if you show that you respect their time. (Of course, if you got a flat tire or starting feeling really ill on the way there, then it would have to be last minute, but still letting them know when you can.)

I really think that the best policy might be that clients get a certain number of cancellations in a certain amount of time. Just throwing out an arbitrary number here, but a client gets two free last-minute cancellations in a year, then if there's a third one, they have to pay (and then it would reset the next year).

It is 200 AUD and that is a pretty standard fee in my area for a clinical psychologist.

As I said earlier, I am the only client my therapist sees in the office on Wednesday so the option to fill my spot with another client is very unlikely regardless of the amount of notice I give. She is a psychoanalytic therapist so she sees clients at the same time and day every week so that's another reason she would not be filling my spot if I cancelled.

Ah, I see. That's part of the frame for psychoanalytic, right? She still could be more lenient.


I hope conditions have improved in your area regarding the flooding..

Exactly at what time did you expect the email from her? How early? Did she know beforehand how early you will want a notification under such extreme circumstances? She needs to be informed in time of your expectations if timing of communication is of such importance to you.

My opinion is, I would not take a messaging personally that's about a discussion of impersonal circumstances and conditions i.e. scheduling of sessions. Even if the person is close to me, even if I am very attached to them. I find making the outright impersonal into a personal topic just blurs things and makes it harder to communicate in a discussion.

In general, if you wish to test her attitude towards you, this is not the best kind of opportunity to do so. It would be way too ambiguous an opportunity for that. Most situations will simply be too ambiguous for that. Since this is a close, attached relationship for you, IMO best to drop any intent to test, and just simply bring up your issues with trusting her attitude, and talk it out with her. If you find you absolutely cannot trust her enough to discuss that trust issue with her, it's time to find a new therapist where you can build better trust.

I agree that under such extreme circumstances it's normal to want to make sure that the session will still happen as usual and whether it will be in the office or online. I would also be uncomfortable with the ambiguity and would just ask them for information as soon as I think of the issue, plus let them know that I'm still able to come (or not).

As for her not checking advice, yeah, I guess she's a fallible human being.

I'd again try to not involve any personal feelings in assessing the issue and would discuss it as an impersonal matter to try and find a solution, compromise, whatever. Either way, I'd definitely mention that I think under extreme or special circumstances there should be no charge. That just seems reasonable to me. Whether such special circumstances include unexpected changes with the work schedule, that's I guess at the therapist's discretion as a service provider. Say, if the unexpected changes happen frequently, then it's just not workable for most providers to cover for all of it. But a rare special or extreme circumstance, sure. I would see that as perfectly reasonable to waive the fee then.

If she won't do it even then, or simply won't accommodate your preferences for the regular schedule, it is up to you to decide if you are willing to work with her under those conditions. Up to you to evaluate if the pros are still worth it more than the cons. That's completely and entirely in your control to evaluate and decide that. Managing your attachment is also in your control. See more on that a bit below.

You don't *have to* disrupt your work schedule. You can find another therapist, you can even find another therapy approach if psychoanalytic doesn't work for you anymore.

And if I were you, I'd again want to see it as, my own decision on whether I'm willing to adjust to the therapist's schedule, leaving her personal needs out of it. I do subscribe to the camp that sees therapy and the therapist as a professional service being provided by a service provider who's supposed to be an expert at providing it. As providing therapy definitely requires expertise if you want to have it actually working and improving your issues and symptoms. I will again admit that I don't see psychoanalytic therapy as evidence based enough, at all.

What do you mean by, this is a pattern of behaviour? How would you put it into words as to what the pattern is?

I can see one pattern, which is, she doesn't seem to have time to notify you early of all the changes. I don't know how many other clients she has to manage scheduling for, or how much she's aware of your need to be notified early enough. Or how early is early enough for you.

I would still not see it as part of the personal relationship, as it's just about scheduling sessions. If I were her, I would not even be willing to discuss my personal reasons (such as being tired in the evening) for why I wanted to move the sessions. I'd be courteous in notifying the clients but would not discuss in such depth. My clients can either decide to accept or not accept the change. (Maternity leave sure, I could share that reason, but not how I feel in the evenings. That's completely in the sphere of my personal, private life.)

Not the first time that I'll say this on here.... if I were to find myself this attached to a therapist that I make the impersonal into personal too, I'd just run. I admit that I personally don't find it helpful for me to get that attached. There is a reason why I no longer try to do "deep" therapy like that. Let alone psychoanalytic therapy.... Or if I was trusting the therapist enough, I'd try to make it an opportunity for discussion on my emotions about it and figure out how to bring it up and make it into such an opportunity for learning more about my feelings, myself, trust and intimate relationships in general.

So, it's fine to be upset by all this, I mean, fine to feel upset, and of course don't invalidate it by calling it "oh I'm just overreacting" right away, but you can try and view it as a chance to process the feelings in the context of the attachment and the relationship.

I would suggest doing some cognitive-behavioural analysis on that. It's common to assume what the other person thinks or feels, but it's always just a guess, never reality. Without further information or disclosure from that person, it's not a reality or actual fact. Same applies here even if it's a bit different (as a parallel). Whatever reasoning you think she should be able to think of right away, it may not be the reality. Unless you explicitly told her before about this issue and she already let you know that she fully understands your wishes.

I understand that it feels hurtful. Just be aware and prepared that she might see that as an argument, too. I hope she will be able to understand that you are not "just trying to argue" but that you genuinely are looking for a resolution and for your feelings to be understood. And maybe some help with processing them, by viewing the "argument" as a good opportunity for that.

Says "all", as in?

I agree that it would be ridiculous but I'm not aware that she actually said that? Since your cancellation was about work, not about the natural disaster ruining your day? And yeah, I can understand the need to keep things clean as in, on professional terms, and yeah, that would not have to be ruined by having clear exceptions for extreme circumstances. Which would either be well-defined in advance, or with a decent explanation given to the client if the particular situation is not covered by previous definitions.

It is fully in your power to decide how much power you want to grant someone else, yes even in an attached relationship. If I were you, I would want to focus on how to achieve that. It's part of having interdependence in a relationship.

Furthermore, just my opinion about therapy, but I would disagree that the therapeutic relationship is supposed to be about giving up power like this. I'm strongly convinced that that would just not be helpful to the client in the long run.

The significance of the therapeutic relationship is not to do with making the client emotionally dependent and powerless. It's supposed to be quite the opposite! It's supposed to be rather empowering, helping with developing interdependence, and so on and so on. If therapy does not achieve that, it's not working. Either the therapist or the approach or both is/are not matching for the client.

(Very personal view: I get it that having to experience difficult emotions, feelings can require putting the control aside and previous intellectual assumptions. But then (general) you have to recover back to your normal way of being, fast enough, without becoming so dependent emotionally on a therapist.)

I wouldn't be sure that her lack of flexibility is necessarily about trying to take advantage of her clients. Does this possibility fall in line with what you've experienced so far over the years of the rest of her character? Where do your current trust issues with her come from? All that's maybe worth a look. Whether on your own or with her (if you can trust her enough to discuss this with her).

And if you find she's deliberately tried to make you attached and dependent to her beyond a point where it does feel out of your control, then it's time to leave, IMO. But it would be hard to prove such manipulation from this little information. It would need more information and analysis and some understanding of your gut feelings to decide that. That it's deliberate manipulation, or her lacking expertise for your case, or her approach not working for you and so on. That's how I see it.

And finally, as far as leaving this therapist to find another one, you don't have to switch so abruptly if it helps have a transitioning period to make it less traumatic. You can even start therapy with the new therapist before fully leaving this one if that helps make it smoother.

Hope some of this helped. I wish you the best luck to all this!!