Sliding-scale Client; Suck It Up Or Quit? Long (thank You!!)

[jedikit]

Hi! Looking for opinions as I’m not trusting mine too much at the moment. Details (apologies it’s waaay too much but I’m trying to examine this from all angles to make sure I’m not just over-reacting). Thank you so much for your time/efforts if you stick with me here through a wall of text:

For the past 1.5yrs I've seen a SE Therapist weekly 45-50min; she runs a private trauma specialty practice. No insurance accepted and other therapists have told me she’s pretty pricey for my town at $165/hr... but she agreed to a sliding cash scale $120 for me. This past September I was laid off from my job, had surgery pop up I had to pay $5k deductible for, AND my victim services funds ran out (had been receiving $500/mo for 7 years). I told her because of all this I’d need to back off from therapy a while. She was totally cool, told me she didn’t want me to have to do that and dropped her rates down to $80/hr for as long as I need. Times are hard (for us all, right?), I’m currently back working temp jobs and have been paying her $80 cash each week.

To be fair, the reason I found & was referred to this therapist was because my original longtime beloved bi-weekly EMDR therapist said she thought I needed more specialized care than she could provide and that she believed I’d do much better in a Group environment as an adjunct to regular talk therapy. So I found this specialized trauma practice for a consult for their 7-person ladies group… but upon consult, the SE Therapist told me she didn’t think I’d do well at all in a group and she wanted to instead see me individually to work on my dissociation & developmental trauma.

I like this lady. Only Therapist I know of in my area who works with dissociative patients. Her modality has worked for me and I’m much more present than I was a year ago. We haven’t touched at all yet on my trauma; only work on resourcing, pendulation and staying within the activation threshold on day-to-day stuff. She has told me about her own trauma (incest) and how she’s still healing from it – it has come up when she tells me she’s having a bad day and needs to reschedule. I admit, I’ve googled her and read her news stories (as I imagine she probably did about mine). She published her first book this fall and has been busy with everything that goes along with that. Even though I’m working blue collar, my town is a pretty flush/tony area and her practice treats a lot of upper class sex-addiction, divorce and video-game addiction families with much more financial resources than I have. I always feel pretty out of place in the waiting room (think of a very rich dentist’s office) so I'm usually most comfortable with appts in the late evening when I’m the last one there.

I’m only this Therapist’s 3rd private practice patient when she opened 1.5 years ago (she just got her LMFT-A this September; yes she was an intern with a supervisor when I started seeing her, and yes she was just out of college/boards when she opened her practice).

The practice also does group Trauma Sensitive Yoga classes 90min for $35/once a week. I was their very first yoga client and have stuck with it the longest (only based in luck as my daytime job was flexible enough at the time – the class was at Noon once a week). The first yoga instructor disappeared one day after I had been seeing her weekly for 6 months. When I asked, my Therapist just said she no longer works here. So after a month break from yoga, I was told they got a new yoga teacher; I loved her too. We worked 3 months in small 3-person yoga group, and then she went to bat for me with the therapist saying I probably needed private yoga lessons outside of group. I stutter and don’t do well in a small room full of people; I’d leave yoga every single week with either a super bad migraine, throwing up or else totally checked out (got in a wreck once afterwards). I couldn’t afford the offered private yoga sessions at $85/week, on top of what I was also paying for therapy so the Therapist just had me pay the group fee of $35/week for individualized 60min private instruction. Cool! 2nd lady worked with me for 3 months... until my mess in September and my job made me go back to the office for a month 8-5p (until they laid me off). So I couldn’t continue with the 2nd lady because she was commuting 30mi away and could only do Noon sessions on the days I couldn’t. Sad.

So my Therapist ended up putting me with another yoga teacher, my 3rd, and I’ve been with her each week since the September mess. And my Therapist on top of this offered for me not to pay for the private lessons at all; just pay my $80/wk therapy sessions until I could go back to paying full price. I put up a huge objection and I feel seriously stinking awful, like a total free loader but the therapist urged me that she keeps 2 slots on her books for pro-bono cases and they’re learning as much from me as I was from them, ect cetra, ect cetra. I’m working super hard at looking for more than an hourly temp job to cover my bills but haven’t been so successful so far.

So at Christmas, the 2nd yoga lady emailed me to see how I’ve been doing and wrote the, “Hey, let’s do coffee” nice thing to say. I don’t do social engagement so well so I responded, “Yeah sure, thanks, anytime!” because I thought that was the polite thing to reply with. So she responds with, “Let me check to see if it’s okay with the Therapist” and I’m saying, “No-no, its okay, no biggie”…she replies with, “Therapeutic boundaries, I can only see you up here”… and I felt awful at that point and stopped responding to emails from her.

So last week, my Therapist says she’d like me to resume coming to the Noon private yoga class with the 2nd lady AND also my evening private lesson with the 3rd lady so I can get the most out of yoga since it’s free & available to me. I felt super bad but grudgingly agreed and asked off my temp job to do so.

So on Thursday Noon I show up to yoga and it turns out, it’s really back with the ladies group; overly full this time with 7 people in a 200sq ft room. And I get anxious halfway through, excuse myself and go yack in the bushes in the parking lot for half an hour. Home with a migraine, one eye swelled shut for the rest of the day. Okay, so my fault there.

So I go to weekly therapy yesterday and when I sit down, the Therapist starts off telling me the 3rd yoga lady is “moving on” and Therapist now wants me to continue back with the 2nd lady… but if I’m not okay with that, she wants to know right there if I'd prefer to stick with the 3rd lady with private lessons. Huh? I’m taken aback and tell her I can’t do the Noon yoga as my temp job usually precludes it, aside from asking off this one time. I know I must have looked confused, and I asked the therapist if she feels I should start with her DBT group or something, does she feel I’m ready? She says no, she still wants to see me weekly for individual therapy, and that it’s perfectly fine if I wanna stay with the 3rd lady for private lessons. I’m super confused and get flustered and we only worked on grounding the rest of the 45min, talking about the inauguration and current events.

Sooo... this morning at 7am, the 3rd yoga lady texts me… says that I should have heard by now that she was let go by the Therapist/practice… and apparently just like the 1st lady was a year ago (I had absolutely no idea – thought 1st lady just disappeared one day). 3rd lady wants to say goodbye and let me know that she wasn’t just abandoning me. WTF??? Huh??? I was expecting to see her Monday evening at private lesson! Guess not now. Confused.

So I know I like this Therapist and her practice a whole lot, other than feeling like a charity drain. But, the cons are she cancels on me the day-of a lot (I keep track, it’s at least once a month since I started with her). She schedules me different days/times each week, lets me know by text the day before when she can get me in (and sometimes she pushes to the next week). I once asked for a set schedule but she says she can’t do that, doesn’t know what things will be like from week-to-week or what other clients will need to schedule… and to be honest, as I’m paying so little I don’t really feel I’m in any position to push for consistency. She’s late every session by 10-15min and there have been 8 occasions in 1.5yrs where I showed up and she ended up not coming out of her office, or coming out into the waiting room and canceling right there. She always apologizes though, mentions she’s still working on her own healing, or she's worried about the weather (we're in the south).

I feel like as I’m on a sliding schedule, I should either suck it up and deal with it… or stop going. She just came back from a month break last week after saying she’d email and check-in with me each week to see how I was doing… but she never did. Granted, I probably could have emailed or texted her if I needed to, but I didn’t want to bother her on holiday. She often forgets what we’ve discussed week to week… but she’s really great at getting me to stay present. She’s super smart and tolerates my need to have everything explained (I intellectualize as a distraction method).

My super long-winded question… should I expect to be treated lesser because I’m a sliding scale patient? I’m not exactly white trash but I know I’m not one of her wealthier clients. Should I tolerate never knowing when my next appointment is, being cool with the cancellations and rotating yoga teachers… because they’re the only trauma-shop in town? Am I overreacting?

 

[Suzetig]

No. her behaviour is unprofessional and unacceptable - her choice to offer a sliding scale fee should in no way affect the quality of work she does with you or the professionalism she shows.

To be honest I think you're seeing signs of her lack of experience, doing trauma work in private practice right out of training is a stretch to say the least - it sounds like she's lost sight of her own level of competence and hasn't learned about the complexities of running a business.

Apart from anything else, keeping you in therapy when you're clear you can't afford it isn't a kindness. You can decide to stop, challenge her about her behaviour or keep going as is but no matter how little you pay, you deserve to be treated with respect and dignity.

 

[Muted]

I agree with @Suzetig . Regardless, if they see you and charge you based on a sliding scale, that's the agreement and you deserve the same level and quality of treatment as anyone else.

It sounds like you have been more than patient with their inconsistencies and continuous abrupt changes. Is it possible to go back to your other T, since you've worked through some of your disassociation?

 

[BurgersandFries]

Hi! Looking for opinions as I’m not trusting mine too much at the moment. Details (apologies it’s waaay too m...

I'm so sorry you're going through this. It's not right that she is treating you this way. Whether you pay her the $165/hr or $0/hr, it doesn't matter. She agreed on an amount that was acceptable to her-that is the new full amount. Her unprofessional manner towards you is shocking-late, no-shows, last-minute scheduling-has me seeing red! She is treating you with a total lack of respect.

You have every right to feel comfortable in her waiting room area and expect to be seen at regularly scheduled, on-time appointments. Also, if she says she is going to contact you or do anything on your behalf, you have every right to expect that she would be professional and follow-thru with her word to you. If she doesn't, you need to ask her why because of your trauma background and trust issues. Breaking her word to you re-enforces that lack of trust-in her and in others. It appears as if she is treating you as less-than. That is your perception and you need to talk to her about this. It would be very therapeutic for you. Believe me, there are lots of millionaires that are "working class" and look like it, too. (Look up Dirty Jobs by Mike Rowe.) If you want to change your attire to feel more comfortable, check out PinTrist and shop at consignment stores to update your style. Everyone wants to fit in and feel comfortable in their environment, I know. By the way, this is also a topic for discussion with your T. Let me state this very clearly, your value has nothing to do with how much money you have in the bank or what you wear or what you drive or where you live or who your friends are or what you look like-your valuable because you were created. You are alive. Don't you know that you are worth so much more?

Be well.

 

[Arebas]

I agree with what's already been said, you deserve better. Much better. But being realistic, if that's the only option you have, you also need to accept that this is what you can get. For now. It doesn't matter how much you pay when she has agreed on your fees. If she's not willing to do her job under those conditions she shouldn't propose those conditions. It's her responsibility towards you to provide the services you're paying for, no matter what amount it is. Even if she offered it pro bono, for free, you deserve the service she offers. But I don't care how great she is - or others say she is - the way she treats you as a patient leaves a lot to be desired. However, seeing that it's your only option for the moment, I'd take a deep breath and keep going. Remind yourself that she is the one not doing her fair share of the job and try not to let frustration get the best of you. Try to benefit from what you can get out of the situation and work on your recovery the best way you can. You're not overreacting, this is really a shitty situation that you're in. I'm sorry.

 

[jedikit]

Is it possible to go back to your other T, since you've worked through some of your disassociation?

Thank you (ALL) for responding! To answer the question first... I actually still see my original EMDR therapist bi-weekly... however, both therapists work as a hands-off philosophy so there's no conflict between their styles; the SE Therapist doesn't want to know what the EMDR Therapist is doing. They don't collaborate as the SE Therapist doesn't want to. The EMDR therapist I work with on day-to-day functioning for the past 4 years. The SE trauma Therapist is just supposed to be only-trauma.

So yes, I could stop seeing the trauma Therapist... but I... I have no idea if I should. I'm much more present, and I know it's 100% her doing. But I feel bad about myself at the practice, and in front of her. I do feel "less-than" -- not to make it a pity-party, but there just are folks that don't have as much value as other folks. Period. I'd love to learn about style and redressing... but I don't even know what I like about myself, much less how to pick out clothes. I could spend all day on Pinterest but I couldn't tell you what looks nice. How does someone do this?

Follow-up question... at what point should you just cut your losses in therapy? I can bring all my issues up with her in an email, or bring in a letter in session (I stutter too much to articulate when I get anxious) but the outcome is going to be the same: she'll explain & justify and I'll feel stupid and it'll be awkward for a while in session.

One thing I know for certain... this Therapist is not going to dump me or refer me out; she's too good for that. I've heard of therapists just making things difficult for their clients on scheduling so they'll quit... right or not, I know it happens. True, a good therapist would just be honest and up-front. But sometimes a good person's intentions fly out the window when faced with their own inadequacy. It's much easier to look away instead of doing the right thing.

Much too socially awkward to see the signs for myself... when is it best to be the first to leave therapy?

 

[theshadowoftheliving]

I once was in a similar position. The clinic had its own standardized sliding scale, which they further reduced for me. It set up a really uncomfortable power dichotomy between me and the therapist where, likewise, I didn't feel like I had the power to complain about what felt like unfair treatment. I ultimately ended up finding a new therapist who takes my insurance and it has been a really smart and important move for me. It was hard to switch therapists, certainly, and there was a lot of commotion about it, but now I have someone whom is dedicated, reliable, and whom doesn't have the upper hand over me.

I'll never be put in that position again. Looking back, it was a really terrible divide of power that shouldn't have occurred.

So, it might be worth it to look for someone else.

 

[Suzetig]

One thing I know for certain... this Therapist is not going to dump me or refer me out; she's too good for that.

No, she's not too good - you'll be helping her establish her exoeiebde as a trauma therapist so it's not in her interest to refer you out and in the meantime she's behaving terribly.

You don't have less worth than anyone else, you have a right to the same kind of treatment and this may be a place to practice standing up for what is rightfully yours. You already anticipate her being defensive and justifying herself, what's making you expect that response from her?

 

[Muted]

Thank you (ALL) for responding! To answer the question first... I actually still see my original EMDR therapist bi-we...

Have you ever taken a break from your trauma therapist to see how you did as far as your disassociation symptoms on your own?

Is it possible for you and your EMDR therapist to instill/strengthen the improvements you've made thus far of being in the present?

Your trauma therapist may guide you, but YOU are doing the work and YOU are staying in the present. Therapy is draining because it takes a lot of energy and work for both the therapist and most definitely the client.

It kind of sounds like your trauma t is doing as much harm as she is doing good. But I am also hearing your going to even that location is stirring up some feelings. It might be worthwhile to target this feeling with your EMDR therapist and see if it's connected to any past trauma or events.

It doesn't feel like you are feeling heard by your trauma t and to me that is a red flag. I also stutter and can't get my thoughts out often when I'm trying to verbalize something, but it concerns me if you don't feel like your t is patient enough to wait for you to articulate what your saying and ask questions if she doesn't understand. The more comfortable I am with someone and the more patient they are, the less I struggle to get the words out.

It doesn't feel like you're feelings are being awknowledged. You shouldn't have to continually bring these issues up. If you tell her how you feel once and she's still responding the same.. then truly I don't care who she is, or what kind of training she has or how much money she makes, she is NOT too good and she might need to consider what things are like on the other side and maybe she needs to think about why she wanted to become a therapist in the first place. You deserve an honest and straightforward response.

As far as picking out clothes, I thing that's a great idea for a new thread!!! :)

 

[theshadowoftheliving]

I'm going to echo @Gia1019 here. Maybe it would help to step back for a while. When I went through my disastrous transition, I went from two 90 minute sessions a week to just one 50 minute session. My therapy contact hours, in effect, were cut by two-thirds. And interestingly enough, I started to improve rapidly.

I think, for me, it was draining to be in that much therapy. Having more time for myself has actually allowed me to process things and attempt things on my own, and be more independent. I was worried when the change happened, but I think it was ultimately good to scale back. It sounds like more time for yourself could help you focus on finding work and settling life stuff down, which might be more helpful than trauma therapy at this moment.

 

[jedikit]

You already anticipate her being defensive and justifying herself, what's making you expect that response from her?.

Experience. I've twice brought up how I was upset with her on this stuff and she gots dismissive and chalked it up to my "transference."

Example: I'd go into session and the first thing she'd bring up when I sat down would be, "And how are you planning on taking care of yourself while I'm traveling for the next 4 weeks?" ..... ???

... Well since this is the first I've even heard of you leaving for the next 4 weeks... "Ummm... I didn't know you were leaving... can I think about that and get back to you? She'd sigh and look at me like I'm a forgetful child.

This has happened several times. I feel stupid; ask who was supposed to tell me and she gets defensive and says she's been super busy, or... didn't the secretary tell me?, or, ...oh, I guess I forgot to tell you, oops. So then I feel like I wasn't worth it to tell... like she remembered to tell all her other patients, but just not me for some reason. Or... or then I feel like my mind is not as reliable as I thought. And I really hope that's not the case because my whole world thrives on organization, boarding on OCD; I bring a notepad everywhere I go and am constantly jotting down stuff. And me being forgetful doesn't ever happen with anyone else. I'm one of those sickeningly punctual people everyone loves to hate (ex-Army brat & spouse).

Happened with the yoga on Friday, happens literally every single time she's going to leave that next week to travel. I'm totally okay her being gone; hey people travel, people go on holiday. No biggie. But I feel like I must look helpless or something. I know some people are reliant on their therapist, and that's totally cool because that's where they're with their healing. But I'm pretty independent, so her being gone doesn't bother me as much as the, "Well, didn't you know?" aspect of it.

So yeah, I expect her to get very defensive.

 

[Muted]

Another option might be to see your EMDR t on those off weeks in place of her. That way you would still have the support of being seen weekly.

I agree with @theshadowoftheliving about it being draining and stuff, but I also think it might help you to make the change gradually with support still there. This might also help you adjust to not seeing the trauma t.