Linners820

Hey all. I have been having an issue lately and am not sure where to post this. Looking for advice. I've been seeing a therapist that specializes in addiction and trauma for the past year. I have insurance but it's very minimal in regards to what it covers and have been paying the session fees out of pocket. I have recognized that there's a whole lot of past stuff contributing to my addiction that needs to be unwound, so I purposely sought out someone whom I felt would be a good fit.

There was a rough patch where I was having twice weekly visits, but I had cut it down to once a week due to financial reasons. I look forward to my sessions and have gained a lot from them, however at this point in time I cannot afford to continue them beyond twice a month. I told my therapist this in very simple terms at our last TWO visits.

I feel that both times my concerns were dismissed, my past financial situation was called into question (you made it work THEN, so you can make it work NOW kinda sentiment) and then the "you already cut it down to once a week, and I was ok with that, but you absolutely need to be here once a week." Again I restated what I could comfortably afford to do per month, and she said she doesn't do therapy that way and "you'll figure it out" and "It won't be effective if you come just twice a month." I figured me doing what I could do was better than nothing, but she wasn't hearing it and I somehow found myself getting booked for another session next week, with her telling me that I can pay what I can afford and owe her the rest later.

The thing is, I am very uncomfortable with debt (which I have shared with her before), and I've already racked some up due to other recent medical issues. This past week I have felt very angry with her. What it costs me to visit her each week is 3/4 of one of my current bi-monthly paychecks. I feel like I have made a lot of progress by seeing her and don't want to lose her as a therapist, but I want to be able to have sessions as I am comfortably able to have them.

It seems we have reached a crossroads and I have found myself feeling very resentful this week. It has been on my mind to call or text her before my next visit on Tuesday to sort all this out. Can anyone give me some input or advice or experiences with this type of thing?

August252015

Hey- glad you are asking. I too have expensive therapy; my psychiatrist is actually completely out of pocket and it is $215 per session. At first, I went to see her 2x a month and now, headed to 4 yr sober, it's once every 3 mo. It was absolutely worth it.

It (hopefully) could be a situation where her treatment practice/methodology/whatever is exactly what she has assessed and advises based on what she knows of you so far. Perhaps the delivery wasn't the best, but I'd try to look at it this way if it was me- and if I liked and trusted this psych (as I do my own). This would understandably cause negative feelings for you connected to expense- I GET it and have been fortunate that my parents helped me with that huge early burden. At times after 9 mo or a yr sober, I have been able to go with a 1/2 visit at $105 I think. She doesn't offer that anymore as she has cut back her practice.

Alternately, what about another person? I see a therapist (not a psychiatrist) a couple times a month, or every 6 wk, roughly. She's out of pocket but $130 for probably 70 min. I started that last summer for some specific, current issues.

For me, I have to have a psych because of meds. And budgeting- I do understand her point (even if it might sound harsh) and finding money for what matters most. That's where my dr falls.

Hope you find a resolution that keeps you on a good path for you.

August252015

Oh- and I would probably keep the appointment Tu and talk in person. Perhaps have specific questions like you ask here - it might feel risky, but a good therapist for YOU would be receptive to complete honesty, imo.

HeadEast

Oh man, that's a tough one. This is only my opinion, but to be honest I think her saying she can't do therapy twice a month is a truck load of BS. I would look for another therapist. As scary as that thought is, especially given the fact you have a relationship with your current therapist, a new therapist might give you a new different perspective. The financial concerns are real. I see my psychiatrist once a month and he does a little therapy. I would be real uncomfortable if I was told "you'll figure it out". I think I would respond with something that I can't print here.

Linners820

Hey August, thx for you reply. I also have a psychiatrist that I see every 3 months. I can afford that plus my medication. I get what you're saying about the therapist tho--she has had some time to get to know me and this is what she feels I need, and I know it too. She is looking at this like a very necessary expense--like, if you had to have an infected tooth removed and couldn't afford it, you'd work something out and pay it off later. I'm uncomfortable with that, though.

Surrendered19

I'm sorry that is happening to you. A good therapist who cared about her patient would stop at nothing to find a situation that works for you. If you can't afford her, which you told her, she should recommend another therapist who you can afford. I don't think they are required to do that, but a good one would. Shame on her for putting the hard press on you. That is an uneven power relationship and your therapist is pushing you around a bit I think. I work in a profession in which there is a range of options that work for people and good members of my profession always try to find a situation that works for folks who need help, even if they aren't the one.

Linners820

HeadEast, yes, the "you'll figure it out" was upsetting to me. I know exactly what my budget is, and this felt demeaning. As she was pencilling me in for another session, she told me that it was "very brave" of me to get all that out there.

Linners820

I think her giving me the option to make payments on my visits was her way of trying to "find a situation that works for me". Only I'm uncomfortable with it, and I have spent the last few days feeling like I was coerced into something that wasn't my intent, which is the absolute opposite of the point of my sessions.

Surrendered19

No, she knows what the deal is Linners. She knows you are not comfortable with continuing with her. That should be end of story for her.

suki44883

That would tick me off, too. I'd be tempted to say something like...well, if you would cut your price in half, I could come once a week without going into debt. But then, that's just me.

soupcon

I would be angry at her as well. I would say I refuse to be in debt. If she says twice a month sessions are not sufficient, I would find another therapist. She sounds a little impressed with her own power. She is manipulating you.

sortofhomecomin

Linners, I have had therapists before, none were specific addiction therapists and results were mixed. To be fair, one did help me with staying off alcohol for 7 months in 2013. She was very good with motivational stuff in the early days, just simple suggestions that worked. I must say to hear an addiction-specific therapist act like the way your therapist is acting is disappointing. With the therapist I saw in 2013, initially it was once a week, then by mutual agreement we cut back to once a fortnight. She certainly didn't attempt to guilt-trip me or persuade me that I needed to up my therapy sessions. Ultimately, however, we kind of had a parting of ways as I felt she was trying to push religion on me in a way that I wasn't entirely comfortable with.

I guess therapists can be a mixed bag Unfortunately, it's difficult to find a very good one. Sometimes I wonder if they need therapy themselves.

August252015

Guys, I have to thrown in that these folks are operating a business too. We don't know what their past decisions or common practice is about fees - insurance- etc. So I might feel it is unfair that someone won't "make me a deal," I also know there is a limit to that. My awesome psych has definitely worked w me over time- we've gone longer on those 1/2 sessions, she has seen me a couple of times same day with a crisis- one time, we sat on the floor and counted out my meds bc I was confused on what I had taken. That was right when I got sober. So yes, she is very valuable to me even when I don't "like" the cost.

I've also been to people who flat weren't worth the money I get that, too.

Ultimately, linners, you are trying to take care of you. I haven't found that a linear process! Remembering it is more than OK to stop seeing (even a good) person or change- and possibly return to that first one! - is important.

sortofhomecomin

August, and I say this with respect, remember the expression 'take care of our side of the road first'? Whether therapists are charging too much or too little is not our concern, as clients. Whether or not they are even covering costs is not our concern, as clients. I interpret the issue in this thread as being about the OP feeling unduly pressurised to have a certain number of sessions per week.

I would have to admit, speaking as a finance guy, that in my experience, some therapists charge too little, but we wear different hats, as it were. Meaning we can't solve every problem in this world. Meaning, if I go see a therapist, I try and not get into thinking about what their financial situation might be and over-analysing that side of things.

Realistically, when it comes down to it, I pay €65 to see my doctor once or twice a year to renew my prescription and I maybe get 5 minutes with him, 2 minutes of which is checking my BP which I can do myself at home. When I saw therapists, it was €65 for a full hour, and it was one-to-one. I honestly would have paid more than that at a time when I could have afforded it. But, currently, I barely have the cash to pay my doctor once or twice a year. To be fair to myself, not all of this is due to alcoholism.

August252015

I took it as about money. Which of course is tied to number of sessions. I was just pointing out as an addition to my first post, that jumping on the therapist for cost (as I read several posts) seems to be indeed taking on the dr side of the st.

Shared all of my above thoughts based on experience, including practicality and decisions w multiple drs. We all put our priorities on $ spent/benefit received in different ways, on diff things. Hoping any of our contributions can be helpful to the OP.

Steely

Sometimes it is not affordable, and that's it.

Eat, or receive therapy?

Having no money as a result of paying for a therapist can be very detrimental to mental health. Any therapist worth her salt should know that. Maybe she's going broke? Needs the clientele.

It doesn't sit well with me.

Linners820

Thanks for the input. What's bothered me is that a lot of my work with her has to do with building assertiveness and setting firm boundaries. She likes to remind me of JADE (I don't have to justify, argue, defend or explain my choices) and that when I need to be firm most of the time saying "that's not going to work for me" is sufficient. However the last visit I felt all that went out the window as I felt like I was put in a position where I needed to do all those things. There has been an element of guilt-tripping me and...how do I explain it...kind of stressing how badly I need to be there once a week for my own good because I'm such a mess (the last 3 words weren't used but that's the gist of it). Like using my own issues as a way to reduce my self esteem and feel dependent on her since she can "fix" me. As Soupçon said, I felt manipulated and that she is taking advantage of the some of the very issues that brought me to therapy in the first place.

The financial stuff is absolutely real and Steely brought up a good point. Being in therapy even though it's going to cause me to go into debt is definitely not good for my anxiety and mental state. I also feel like I've seen a different side of her where everything she's been teaching me applies, just not with her. At this point I don't feel comfortable, period, which is disappointing.

I have been stressing about this interaction. What to say, when to do it (call this weekend to cancel future appointments or pay another session fee so I can go thru the whole thing all over again?)

Again thank you for listening as I work through my thoughts here.

Steely

A case for universal health care imo.

I couldn't possibly afford a therapist on my current income. I could, and did, in the past. But no way in the world, now.

Our system here allows for people on low incomes to still receive therapy. In the end it works out better for everyone. Fewer hospitalisations, homelessness, DV, etc, etc. The public purse is spared.

I cannot, for the life of me, understand why money is a determinant for mental health.

Hawkeye13

I would cancel this next appointment no matter what.
You cannot afford it and you feel coercion.

Either reason is sufficient to cancel, but together seems pretty clear.

If she want to call you to discuss on her dime, tell her what you told us here.

Derringer

I couldn't afford much therapy but from the little I did do
​​​​what I found is that most of them have simply developed strategies from books that have been around for years.

The key to using books for me, is that just like going to a therapist once isn't going to be of much use, neither is getting through a book in 1-2 weeks and going "okay read that, now what"

Study the book, read it a number of times, refer back to it, underline key sentences and paragraphs, write them out, stick em on the fridge.

It's worked for me and it's probably cost me $60 NZD in mostly 2nd hand books over 5 years.

I'd hate to think what weekly therapy would have added up to.