Couch 243: Winchester Cathedral

It sort of sounds like arthritis or some sort of systemic inflammation. I had to completely change my diet due to inflammation/arthritis - and it has helped along with a couple of joint replacements and pt - but pt without inflammation reduction was useless for me

We've talked about it before. It just feels awkward to bring up because it feels like you're devaluing their work, even though that's not how I actually feel about it. He emailed me this morning to confirm what my co-pay this year is and sent me an updated invoice that was like mid-three-figures that included about 5 previous sessions where he forgot to charge me the co-pay. I missed it previously when I'm usually pretty good at catching any errors. I wanted to verify the dates and noticed that in a previous very large invoice he charged for a full session when we only did a half hour video session that day. I responded to his email informing him of this previous error and told him that these very large invoices are having an emotional impact on me. I didn't explain, but I think he knows. I suppose I could have just let that 15 minute extra charge go, but I was feeling like if we're going to nickel and dime this relationship, let's just nickel and dime it accurately. We're supposed to meet tomorrow and I don't want to go because right now it is feeling very transactional. Probably doesn't help that the last two times we met, it kind of felt like I was being shoved out the door at the end of session.

Great. Now I've pissed him off. Not sure where to go from here.

The tone of his last email was kind of hurtful so I told him to just cancel our upcoming sessions. I guess we'll see what happens.

I'm sorry, NP. I'm sure y'all will work it out. it's hard though, this therapy relationship. it feels so gol dang personal and friendly sometimes, and half the dang time i'm still wishing L and I could be friends.

The first rupture I ever had with her many years ago was over money. It's such an 'ugh' subject.

I'm not sure how to get past what he said in his last email to me so I can continue to work with him. Is anyone willing to read it and give me some suggestions? I'm not sure I feel comfortable quoting him verbatim publicly.

I'm happy to if you want to PM.

I'm sorry you are experiencing this.

I will state publicly that because I use insurance, he has a contracted rate with the insurance company which means he can't charge me more than that rate. Apparently, my insurance company rate is a little over $100 while another insurance company that I'll be switching to in June pays more like $150 - $200. I think he only accepts my insurance because he took it when I started with him. He quit taking it at some point but I was kind of grandfathered in. The rate I pay him is because of my insurance. His email is bringing up that basically he's given me tens of thousands of dollars of heavily discounted therapy. This is not my fault, but I feel terrible and like an expensive burden.

NP - It definitely isn't your fault or responsibility. Whatever discount HE allowed was HIS choice. He could have said no at any point. This is on him; not you. T and L gave me sliding scale. L, who doesn't accept insurance, is choosing to go through my insurance to help both of us out (her getting paid more, and my sessions are cheaper). This is her decision. She had to decide her boundaries and limits so she could offer is wholeheartedly.

I'm sorry you're going through this!

NP I agree with Scarlet, this is not your fault or responsibility. I may have misinterpreted so forgive me if I did but if he is unhappy with his previous decision to take your insurance, there are much better ways to discuss it than to leave you feeling hurt, and responsible for it, and like you are a burden. I'm so sorry you're dealing with this.

NP - I'm happy to take a look at his email, too, if it would be helpful to have another set of eyes on it and another perspective. I have worked through a number of ruptures with my T, some of which took heroic effort (effort it seemed worth putting in all considering).

Feel free to PM me! I can get back to you tonight.

Did he actually *say* that he's given you the discounted therapy? Or are you just reacting to that from the email?

The reason I ask is that my T is self-pay/no insurance, but we agreed on a discounted rate a few years ago based on what my insurance reimburses (he does sliding scale). He recently raised his rates and said he would keep mine at the current rate for at least a year (and then we could renegotiate if needed). Because of something else that happened with insurance (it's complicated--my insurance is incompetent and inconsistent) and a conflict that ensued, I started to wonder whether he'd actually been resenting me for a long time for paying a discounted rate.

So I built this whole thing up in my head, like "he hates me." And I was scared to ask, then I finally asked him. He was like, "You asked this before!" (I had???). And he said he had no resentment toward me. That he wouldn't have continued the discounted rate if it bothered him.

And I suspect it's the same with your T. That if he had a problem with continuing to take that insurance, he would have told you. And that he's fine with the payment he's getting. If you're worried, I'd ask.

Feel free to still PM me!

Aww, NP, you can always send it to me to read if you want. i’ve definitely misheard the tone of my therapist’s voice in the email.

SD-i am really concerned that it is arthritic related.
I will never get away from it.My diet is absolutely horrific. I hope that I need to deal with food. Eating disorders suck.

I barely made it through the night last night. I had to talk to my therapist to calm me down. I called a nurse at my doctor’s office who basically told me to ride it out, and don’t need the ER. The main reason I didn’t go was because I couldn’t walk without severe pain.
Today has been slightly better. I’ve mostly have kept my feet in an ice bath.

I am calling my doctor tomorrow.

Well, I paraphrased slightly but "tens of thousands of dollars of discounted therapy" is a direct quote. I sent you the email, so feel free to comment here if you think I'm misinterpreting or being too sensitive. I just didn't want to post his email verbatim, but I'm more than willing to discuss the issue publicly.

It just feels like he's thrown it out there that I'm costing him a lot of money over the years by seeing me at this rate and although he says it's fine, is it really if he's bringing it up? How am I supposed to go see him knowing he could be getting so much more money for his time? He knows it, and now I know he knows it. I just feel like this is one of those thoughts you don't need to share with your client.

He's emailed back to tell me that he has some thoughts about what is happening with our connection and that it's not really about money or invoices and was I willing to meet tomorrow to talk about it.

I responded: I don't know if this was the right answer and I've probably just irritated him further, but it's how I'm feeling right now.

**My company is switching insurance providers in June to one that will pay him better. He knows this.

I admire your ability to be so honest about your feelings, NP. If it were me I would have hung my head and been all "okay. whatever you want."

ugh i don't like that about myself.

I'm really sorry you're dealing with this. I replied to your message. I hope if you opt to meet tomorrow that it's helpful.

Seems to me you’ve given him tens of thousands of hours of undeserved patience the last few years while he waffles on his next career move and his education and whether he’ll still be a therapist…

Ooh that's a good point, @@.

I appreciate this. I will say that he seems to have no inclination right now to make any decisions on that front. Last time it came up, he said that our neighboring state (our metro area straddles a state border) may be allowing prescribing psychologists soon and I think his hope is that he can one day prescribe across the border and keep his therapy practice here as well. But who really knows what he's thinking. I was very patient through all that and it was very painful for me.

Dsability stuff at work. A few days short of a year ago when my mother got sick and never recovered.

I feel very, very disabled. And not in a good, identity-proud way.

Sorry to hear about your university being so horrible.

I'm sorry you continue to deal with this at your job. There's no excuse for them to keep being so clueless and unaccommodating.

Sorry also that a difficult anniversary is coming up. Hugs, if wanted.

So, today a Facebook ad came up for a challenge to walk 100 miles in April as a fundraiser for the American Cancer Society. I've been intending to be more active, so I signed up. H was like, "Go for it, you can do it!"

Dr. T reacted in the opposite way. He thinks it's more than I can manage. And doesn't want me to set a goal unless I'm 80% sure I can achieve it with moderate effort (that's his general philosophy on goal-setting, not something specific to me). Because he's concerned I'll beat myself up mentally if I don't achieve it, which I think is a legitimate concern. But I also wanted him to be more positive about it, like, "Yes, it's a tough goal, but I think you can do it!"

And now I have no idea whether to believe that I can do it or not. (I also need to see if it's like walking a total of around 3 (or 3.2) miles a day, like in my general steps for the day, or if it needs to be "I'm going for a walk above and beyond my normal steps.") Thoughts?

For the record, I've been getting back into walking lately and do a mile some days, but a while back, I was doing walks of 3 miles, just not daily. If it's actual steps in a day adding up to that, I can definitely manage.

3.3 miles a day...a challenge, but I think doable. You don't have to do it all at once: 1 miles in the morning, afternoon, night. Do you have a counter? Can you wear one all day? I bet you do walking around your house some, too?

I've been riding my bike. I can only do it 3mins at a time. But I do it multiple times a day and in total am doing 33 minutes. That's good for me. I set my goal at 11mins per day.

I say give it a try! The worst would be not meeting your miles goal, however, you would still be meeting your goal of being active! How is that harmful?