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So Upset With My Therapist And Don't Know What To Do

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barefoot

MyPTSD Pro
This is going to be long, sorry...but I would really appreciate any thoughts as I'm in a real state about this.

I've been seeing my therapist for about 2.5 years. I have been very fortunate in that the company I used to work for has paid for all my sessions with her. She charges high fees. Altogether, my ex-work have spent over £20k on my therapy. I feel incredibly lucky that I had that opportunity, although it has always been a worry at the back of my mind that when the money ran out, what would I do?

I no longer work for that company and the sessions they had pre-paid for have now run out - last week was my final session that they had paid for.

My therapist has said all along that, whatever happens, when we got to the end of my paid-for sessions, if I still had work to do we would continue to work together if that's what I wanted to do. When I would panic and protest that I couldn't afford her, she would always be reassuring and say we'd work something out, that she's not he sort of therapist to leave a client hanging, that she charges high fees so that means she can also work with people who wouldn't otherwise be able to afford it, that she's even worked with people for free before etc.

About three months ago, she brought up that we only had ten paid for hours left, so my anxiety and insecurity around the uncertainty has been ramped up since then. Several times over the past few months, I have told her that I desperately want to keep working with her but I can't afford her. Each time, she reassured me that we would work something out and that she "wouldn't abandon me."

My current work and financial situation is dire and I have been honest with her about that - I even told her how much (little!) money I had in my bank towards the end of last year. So, she knows how difficult things are financially at the moment. I am self-employed but work has dried up, a couple of things I was banking on for this year fell through and I haven't felt in a good place in myself so I haven't had the energy, drive, motivation, head space etc to commit to growing my business and trying to dig myself out of the hole I am in. I do have one potential thing in the pipeline that, if it comes off in the way I want, will turn my finances around for at least a few months. Without it though, I have nothing else lined up for now - I know I have to do something about that but I just feel so...broken. My partner is paying for everything for both of us at the moment and it's a real struggle.

Anyway - despite the fact that "what's next?" has come up a few times in past weeks and I always said about being worried about money and she always said that we would work something out, we didn't actually have the conversation about what the working something out would look like. That was partly because I was sometimes avoiding the conversation because it made me feel uncomfortable or because it felt a long way off so I prioritised talking about other topics. And partly because, when I did bring it up and say we needed to agree the plan because I was feeling very stressed about it, she just wouldn't have that conversation. So I started to feel more reassured that she didn't seem bothered about the money and she seemed to just be trusting that it would all work out, so the last few weeks I have calmed down about it and have been trusting those things too.

Then, last week...our last paid for session. I assumed she would bring it up straight away and she didn't so we just had a normal session. Then she got her diary out to book in our next session and I felt a bit stunned because I didn't see how we could book another session in when we hadn't agreed how we were having more sessions/what they were going to cost etc. So I mentioned that it was our last one and she said she hadn't realised (I don't see how she didn't know!) so then she asked me to email her telling her what I can afford.

That felt horrendously uncomfortable and I asked if she could just tell me how much she wanted and she insisted that, no, I needed to email her telling her what I can manage.

So, I spoke to my partner and we looked through our finances and we talked about how my therapist had been about all this so far and all her reassurances and that, seeing as she'd let it go to the wire and was booking a session in with me without us having agreed fees, we thought that maybe the fee wasn't going to matter all that much to her in the short term. Anyway, I emailed her and was very honest. I said what I could manage, said I felt very embarrassed that it was so low and that the last thing I wanted to do was piss her off or insult her. But, at the moment, that's what I could afford and that I knew I had to get more proactive about work so I would do that and I have another meeting about this other potential big project lined up and that as soon as things picked up I would let her know and we could then reassess. It was an excruciating, mortifying, stressful email to write and send.

She emailed me back this morning, thanking me for my email but saying the fee I'd proposed wasn't possible for her. So instead she suggested that as from our next session (which is tomorrow) we do once a month for £80 a session.

I was in the middle of a supermarket when the email came through and I just burst into tears. And I have barely stopped crying since.

I am beyond upset. Disappointed that I can't get what I want/need from her. Humiliated and ashamed that my offer was too low but it's all I can afford. Angry with her because the months and months and months of "don't worry, we'll work something out, I've even worked with people for free before" now just feels like total bullshit. And also annoyed with her because she must have known that this was where we'd end up weeks ago when I told her how little money was in my bank and that I had no work lined up. And she let me carry on thinking "we'll work something out" and then pushed me to send her the email with what I could afford and has now said no. She said last week that she thought doing the fee conversation over email would be easier for me. I think it actually just made it easier for her because she knew she would be rejecting my fee proposal and suggesting cutting our sessions right down and that would be easier for her over email instead of telling me face to face.

How am I supposed to be ok with just starting this new arrangement tomorrow?? With no warning, we're just going from 90 mins a week to one hour a month?! And at a time when I've shared new, sensitive stuff with her, which we haven't then really talked about together. And when I've got a surgery next month and we haven't yet discussed the things to do with that which are freaking me out (She knows there are things I'm freaking out about that I've said I want to talk to her about but I haven't brought these up with her yet because I didn't have any idea that I wouldn't be seeing her weekly until then so I thought I had plenty of time).

I have no idea about what to do about my session tomorrow. The session that's going to cost me £80 and then I won't see her again for another month. I can't see how I'm not going to just sit and cry all session.

I don't know whether I should just walk away. Maybe I have become too attached to her that I can't view our relationship/our work together objectively and perhaps working with her isn't actually in service to me now.

But the thought of not seeing her anymore...I can't bear the thought of that. All I want is to keep seeing her, to find a way to make that happen. And I feel so pathetic about that. But it's like an intense, painful, physical ache if I think about not seeing her anymore.

But even if I can somehow get the money to see her more often (e.g. If this potential work project comes off) I don't know where we go from here. I feel like she's handled this so badly (not just the email today but the whole thing of the last few months) and has strung me along with pretty meaningless reassurances when she must have known weeks ago that this is where we'd end up.

And I know she has offered something - £80 for one hour long session a month. So, I suppose she has "worked something out" and she is not abandoning me. And of course it is her right to decide what fee she is prepared to work for. But what she is now proposing is a long, long way from what we have been doing and to just go to that with no notice...it's really, really hard. And I don't know that I trust her any more. Because now it feels like there's been a whole load of bullshit when what really matters is the money.

I feel so hurt, so worthless and so let down. And so angry with myself and ashamed of myself for getting myself into this position and for being so pathetic and so needy and so attached. I've been so stupid.

So, I suppose the biggest question right now is what do I do about the session tomorrow? Do I go? If I go, what do I say? If I don't go...does that really mean that I'm not going back at all?

And then what? I don't think she will negotiate at all. I think I either agree to £80 once a month or I try to find the money to go maybe twice a month. Or I wait til work/finances pick up and then go back to seeing her weekly. Or I call it a day. And the latter feels unbearable and unthinkable. But I'm sure there will be plenty of people who think that sounds like the best option.

Thanks for reading. And if you reply, please be gentle with me, no matter how stupid or naive or pathetic you think I have been about this whole situation.
 
Wow - I am so, so sorry. That sounds incredibly difficult and I understand why you are so upset, I would be as well. It sounds like she really led you on - and that is deeply unfair to you and your emotions.

What I would do is go to your session tomorrow and come prepared with what you would like to say to her. I think it would be good to bring up how this process has been for you, how she had made promises/assurances that seem to now be untrue, and how hurtful that has been for you. Talk about how you are not sure where to go from here because of that.

Again - I am sorry she hurt you, I would be so upset. You are completely valid. (hugs)
 
This is going to be long, sorry...but I would really appreciate any thoughts as I'm in a real state ab...

sadly thats how it goes, even the most caring and competent therapist will never reduce their fees by much. I can understand it from a "business" point of view - no other industry would dream of it. she should have had the conversation with you sooner however, that was quite devious of her. £80 for an hour is perhaps a little high for a psychotherapist, but quite low for a psychiatrist, so depending on her skill set its a great or a terrible deal. Regardless of that though, if its more than you can afford then it doesnt really matter. I know how it is, i was receiving nhs therapy for a while, but with the waiting times and the frankly poor service, i used all my savings on private therapy, im hoping to be back in soon - but likewise it would probably be monthly as the cost of anything more is just far too much
 
Oh my dear barefoot, I am so sorry and so hurt on your behalf. I too completely believed, based on what you had written, that your T was going to come up with something workable and affordable. Instead, she seems t have embarked on something that feels like a cold business deal. I even find I'm wondering if she thinks you can actually afford more and is trying to call your bluff.

I commend you for writing such a clear and concise explanation of the situation. I know you have said before that you find it hard to speak abut all these things, and I urge you to send her your post, exactly as it is, so she can get a clear view of the situation from your side. I think what you have written shows that you are approaching this both honestly and with all the insight you can muster. To be able to go on working with your T, you need her to do the same.

I disagree that she is offering a generous rate. My experience is outside London, but I have dealt with a very experienced psychotherapist who was prepared to see me at £40 per hour, which I think was less than half her normal rate. I've been looking around, and can find several at under £60 per hour in my region. So I also think you should start looking at who else might be available. I know it is dreadful timing for you, but I think it is important to know that you don't have to face it all with no therapeutic input.

Keep talking with us. You are not alone.
 
This is the reason why therapy is a f*cking scam. No matter how you slice it it will always be about the money. Don't give me the "it's just business" speech because it's never business for the ones being f*cked. Our society is nothing, but a business siphoning your souls. No matter how much you "think" your therapist cares about you they care about the money you give them more.
 
Oh my dear barefoot, I am so sorry and so hurt on your behalf. I too completely believed, based on wh...
Absolutely, £40 - £50 seems a common rate for psychotherapy, but for psychiatry this can be in the hundreds per hour - so if she is acting as a psychiatrist then £80 would be quite good - but for psychotherapy and counseling it really is far too much
 
This is the reason why therapy is a f*cking scam. No matter how you slice it it will always be about t...

i think therapists have to have some level of detachment, when you think about the things they must hear everyday, if they cared deeply on a personal level - they wouldnt be able to function. And they are providing a service - which does many a lot of good, so of course they need to be paid the going rate, i dont think anyone disputes that the therapist here should be paid for her time, but its the manner in which she hid this fact which seems a bit distasteful.
 
My therapist is in London. She is a psychotherapist, not a psychiatrist. She charges £120 a session so I guess £80 is, from her point of view, a reasonable discount.

I am not upset about the fact that she should be paid for her time and I do believe that she has the right to decide what fee she is willing and able to accept/offer.

The things I am most upset about are:

- The proposal she has finally come up with isn't a reflection of the reassurances she has given me for many, many months. Don't insist that I don't need to worry/we'll work something out and don't repeatedly tell me that you have a sliding scale and have even worked with people for free before (I have not ever expected/hoped to work with her for free!) if you know that the lowest you are prepared to go is £80. Tell me that.

- The proposal of 1 x 60 min session a month is a very long way from our current arrangement of 6 hours per month and she suggests we kick off this new arrangement tomorrow - hence no adjustment/transition time for me to help me in managing that reduction of time/support.

- I have been very honest with her about my current financial situation. If she knew that £80 per session was her lowest limit, she must have known many weeks ago that I would not be able to afford that. The fact that she didn't make this conversation happen sooner means that I have spent longer trusting that we will come up with something more affordable along the same lines of current provision. She should have been honest about what she could offer weeks ago. If we'd have had this conversation weeks ago, of course, I would still have felt very upset and it would still have been very stressful. But I would have been able to plan for it a bit e.g. I could have switched to fortnightly sessions to get used to time reduction and to eke out the paid-for sessions a bit more. As it is, if I accept her proposal I'm going in tomorrow for a session I have to pay £80 for to then probably have to talk through all this stuff and inevitably get very upset about it all. And then I won't be seeing her for another month.

- I asked her last week to tell me what fee she wanted going forward and she insisted that I email her to tell her what I could afford/manage. I told her how difficult that would be for me and actually said in the session that I wouldn't be able to write and send that email. She must have known then that I was not going to say I could afford £80+ per session so it feels like she pushed me to ask for something she already knew she couldn't give. So I have finally asked her for something I need. And I wrote the f*cking email, which I found excruciating. And now she has said no to what I asked for and she has offered something far less. And now I feel wrong for asking, ashamed and humiliated. I know it is on me that I feel ashamed and humiliated. But I don't think the way she has handled this has helped.
 
I don't know what to do.

I feel so in the middle of stuff with so many things with her and that all now feels completely up in the air.

Part of me thinks I should accept the one session per month at £80 and be grateful for it and I can afford £80 a month.

But part of me thinks it's going to take me some time to work through this rupture. These sorts of ruptures have taken me a few sessions in the past before I am feeling secure and we are back on track.That's been when I've been seeing her weekly. A few sessions when I'm only seeing her once a month...? That means potentially months when all we are doing is sorting out the relationship. And that sounds crazy and a waste of time. But how do I move forward with monthly sessions without addressing it??

She may be holding out hope that the big work project will work out and then I'll have more money and then I can up my sessions with her. So perhaps she is hoping that monthly sessions will be temporary. Obviously, I hope the project does turn out to be green light go but, at the moment, I have no idea. And if it turns out to be a no-goer I will be devastated on several fronts, not just about he impact on my therapy. Even if it goes ahead though and I get the money, I don't think it is that straightforward...I don't think it is now just about the money for me. Me having more money isn't necessarily going to fix this situation I don't think, because of how I feel about it all. But I think it would fix things for her. And that makes me feel very sad. And stupid. Because it seems that it has just come down to money for her after all.
 
It is sad. You have a lot of your self invested in this relationship and sometimes it's easy to forget about the financial end of it. I can see the hurt you feel, and I would feel the same in your shoes.

I sense you feel an urgency for finding a resoltuion and I get that, but you don't need to arrive at a final answer today. If you want to interview some other therapists, that's fine. It's not a commitment but can be encouraging to know you have options. Maybe there is someone you will click with for a lower fee and closer to home. And you can still expand this current conversation with your therapist to see if this is really the best she can do because it really is beyond your means. There is nothing to be ashamed about, her fee is quite high, it sounds.
 
@barefoot - I think in the short term, you should cancel the session for tomorrow so that you can ultimately make better use of the time, by having a chance to absorb/plan.

Just some things to think about:
The proposal she has finally come up with isn't a reflection of the reassurances she has given me for many, many months. Don't insist that I don't need to worry/we'll work something out and don't repeatedly tell me that you have a sliding scale and have even worked with people for free before (I have not ever expected/hoped to work with her for free!) if you know that the lowest you are prepared to go is £80. Tell me that.
This is 100% fair, and I believe you should send her an email with essentially this statement. It is a really great encapsulation of the issue from your side of things. I would probably make the tone a little more neutral - but the facts are good.

It is also important to acknowledge - both to her, and yourself - that your own insecurities around the topic did play into the outcome. You don't need to beat yourself up about that. It's just a true thing. It's also fair to hold her accountable for the re-assurances she gave you, which seemed to be validating your avoidance.

The proposal of 1 x 60 min session a month is a very long way from our current arrangement of 6 hours per month and she suggests we kick off this new arrangement tomorrow - hence no adjustment/transition time for me to help me in managing that reduction of time/support.
I would suggest you try and not get too hung up on this; yes, it's shitty - but if it's the way it is, it's the way it is. it would be the same if she suddenly fell very ill; or, if you did. In other words, adjusting to sudden change is stressful, always - but looking back on what could have been avoided or not is more likely to contribute to you feeling worse about it all.

I have been very honest with her about my current financial situation. If she knew that £80 per session was her lowest limit, she must have known many weeks ago that I would not be able to afford that.
Nope, nope, nope. Don't go here. Mind-reading her isn't a good idea. She doesn't know the reality of your bank account, and she can't be responsible for guesstimating how much you can/can't afford. No matter what you've told her - people are often not fully up-front about their resources. Sometimes, yes. Other times, no. But more importantly - this line of thought is going to go nowhere except to spin you into more feelings of badness, and that's not what you need right now.
The fact that she didn't make this conversation happen sooner means that I have spent longer trusting that we will come up with something more affordable along the same lines of current provision.
Yes - but also, you could have made it happen sooner. I know you know this - and I'm not saying it to make you feel bad, I promise. I'm saying it because underneath all this is a good - hard, but good - experience in learning about the side of this relationship that is provider-client, which is different from the side that is intimate support system.

I agree, she could have helped allow the conversation to happen sooner. And you, if you're in this situation again, will hopefully know to move through your fear and address the business side of the relationship.


She should have been honest about what she could offer weeks ago. If we'd have had this conversation weeks ago, of course, I would still have felt very upset and it would still have been very stressful. But I would have been able to plan for it a bit e.g. I could have switched to fortnightly sessions to get used to time reduction and to eke out the paid-for sessions a bit more.
That last bit I bolded is important, and she needs to hear this.

The thing I believe she's responsible for is reassuring you that things would continue one way or another, and then radically changing the structure at such a time and in such a way as to leave you with fewer options than you had.

I would be writing an email back, addressing some of these points, and re-framing the question back to her. Tell her what you reasonably believe you can spend for the next month altogether - just assuming that nothing changes on the income side. Ask her how much time she is able to give you for that month. You, think about whether you want to put on the table something as small as reducing the sessions to once weekly 20-minute check ins to keep touching base until your finances improve - is weekly more important to you than one big chunk of time?

And see what she comes back with.

I'm sorry you're going through this - it's hard, and incredibly abrupt, and I think she was really, really sloppy. You'll learn a lot about whether you want to continue with her, from her response to your next email.
 
Her behaviour towards you has been unprofessional and has caused an issue that could have been easily avoided by having an open discussion earlier on.

All of the points you make are valid, and she had a responsibility to communicate clearly with you about money, especially given you raised anxiety about finances repeatedly. Yes, there's a business side to what she does but it's her job to be clear and it feels manipulative to ask you what you can afford and then say it's not enough.

It's reasonable to expect some kind of transition to a reduced frequency of therapy and am I right in thinking you had asked for shorter sessions to enable you to taper off and she said, again, not to worry about it? In your position I'd write to her outlining everything you've said here and ask her how she plans to support you with the feelings your left with. This isn't one of those "therapeutic" ruptures where it's part of the work - it's more due to her avoidance and miscommunication and as such I wouldn't remotely be ok paying her to resolve it. So if you need time to talk it through it should be on her time.

If she won't address the issue with you or try to resolve it I'd be going to her registering body. It sounds like she's really dropped the ball here and that needs to be resolved before you can move forward with her.

You can also choose to see someone else, less expensive. Fees don't necessarily reflect the knowledge and experience of the therapist, sometimes it's about location, office costs and income expectations so someone much cheaper may be equally good.
 
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