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

[Suzetig]

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."

That's nonsense, if she works with the concept of transference she also works with the concept of the therapeutic frame - i.e. that the psychological contract around therapy is part of the therapy so things like being on time, having a consistent session time, the safety of the session from outside intrusion are all part of the treatment process and are hers to hold.

I don't understand how you being upset about her being late, inconsistent or unavailable are down to transference - I'd cut my losses and go to be honest because a therapist who doesn't take responsibility for their own shit will always do more harm than good. You're worth more than that.

 

[jedikit]

Thank you so much everyone for ALL your opinions. You all are helping me to think this through and look at things from other angles. I really needed that. I think what I'm going to do is write this all out and attempt one more time to address how I feel with her, with lots of emphasis on both facts and how those situations made me feel... and try to stick to my guns and not get all stutter-y (if possible).

I really like the opinion stated about money likely causing a power differential... so I'm going to bring up the siding-scale up again in order to set myself a personal deadline to fight harder/faster personally for a higher paying job so I can go back to paying at least $120 by mid-Feb... then, by my second paycheck to her full $165/session. If I can't meet this self-imposed deadline, I'm gonna tell her I want to take a step back from therapy until I can. Period.

I will not start over with a 4th yoga instructor, nor do I feel I'm ready for the established group class so I'm gonna hold off on yoga for a while. I'll start trying more at home with Youtube videos, and forcing myself to get at least 20min more of exercise daily through a 3rd walk with the dog.

If the conversation doesn't go over well... going to ask my EMDR Therapist if we can talk it over at our next session (Feb 1st, so that should give me enough time to talk to the trauma Therapist and see how it goes). I like the EMDR Therapist very much and she's always been great at being a sounding board and not giving advice. Worst case: I do know I can ask for weekly sessions and she does have the room as she told me that before.

I like the idea of taking another break if necessary just to see how I'm doing... to be honest, I wasn't too overly excited when the trauma Therapist came back a couple weeks ago from that 4 week vacation after she emphasized the emailing/texting once a week and didn't, and that whole thing about me not even knowing until the day of. I figured my lack of enthusiasm to resume therapy was due to that... maybe/maybe not. I did okay that entire month; actually had the best Christmas ever, even without a good job. Maybe I am doing better with the dissociation.

Thank you everyone. Now, I just need to figure out how to dress the part :-?

 

[Muted]

Thank you so much everyone for ALL your opinions. You all are helping me to think this through and look...

It sounds like you have a plan and feel good about it. You sound better and it's quite encouraging to hear someone who's moved through disassociation!

I think you could start a thread on how PTSD impacts a persons sense of style and how they choose their outfits, lol. I laugh, but seriously I went from stylish to a lot of rules about what I could and could not wear and what it meant etc...I've never told anyone how bad it was or how crazy I felt (it might feel even safer if it was an anonymous thread):)

 

[One step at a time]

I have definitely thinking a lot about clothing lately, and would love to have a thread for it.

I am glad you are getting good advice about your therapist, here - the "what, didn't you remember I was going to be leaving" thing would press my gaslighting-related buttons, and she sounds generally disrespectful.

 

[ShodokanJenn]

Honestly, this does not sound like someone who is worth your money. She has accomodated you with a sliding scale, yes... but, my T who charges 250 an hour for evaluation and 180 for follow up appointments, did a sliding scale when our insurance changed. His sliding fee was based on my income, so we paid $30 per appointment. He has unexpectedly canceled ONE appointment in the last 6 years, because his whole family came down with influenza. He always runs about 15 minutes late in his afternoon and evening appointments, because of updating patient notes. But the thing is, each person still gets their full 50 minutes, and if needed, longer.

I'm not trying to brag about my therapist, just trying to illustrate a point. Your therapist may be very helpful for you, but part of her job is to be there for you. If she's not far enough in her healing to be able to keep appointments, she probably should be in practice yet.

 

[Veradouglas]

Wow please leave. 80 or 120 that still is not cheap. That's still a lot of money! She is treating you like crap. Canceling 8 classes? Wow. How are you supposed to learn how to trust if this is how she treats you. Being in the present is not the only thing you need to learn. More than anything you have to create a safe and trusting relationship with your therapist. Please leave and take your money and the gift of your presence and life to someone to treats you like you deserve to. You matter and you deserve to be treated much better than this.

 

[Panda Bear]

Sliding scale or not, each patient that a practioner takes on, deserves the same exact level or professionalism. Hands down....

I may not be a sliding scale patient....but my insurance only pays my T $90 per session and his full rate is $125. He could get his full fee from a cash paying client, and from a client that is much easier for him to treat. But he's never treated me with such a dismissive and degrading attitude as your T has. He's never left me hanging, nor has he cancelled an appointment ever in five years.

He values me and I value him.

She's not treating you in a safe and professional manner, I'm sorry.

 

[FauxLiz]

I am in agreement with @Panda Bear I am fortunate enough to have health insurance and don't currently need sliding scale (I did when I was unemployed for 11 months with my past T) My insurance pays $150/session his full rate is $175 but these are the rates my current carrier reimburses and I have no co-pay. My employer changed insurance carriers the first of December, my T rates have not changed but the previous company would reimburse $95/session and I had a $20 co-pay. I guess you could look at is as he got a raise when my insurance changed. But it has not mattered to him what he is being reimbursed he treats me with respect, has actually made accommodations for me that I don't believe he makes for his other clients in terms of scheduling and his availability to me. He is my emergency plan as well in that if I ever feel in crisis I have his permission to contact his cell phone. He does that because my employment creates issues with my utilizing traditional venues such as crisis lines or calling 911 I thru my employment ultimately supervise and manage hiring and firing for all our public safety, 911 dispatchers and crisis line employees. It would be most awkward and more triggering if I am in a crisis and had to interact as a patient with my employees.

 

[barefoot]

Sounds like you have a plan!

But just to echo what others have said - I think she sounds unprofessional, inconsistent and that is treating you badly. Therapists who operate a sliding scale *choose* to do so and, whatever fee the pair of you agree together, the therapist has decided that they are willing and able to work for that amount. It should therefore have no bearing on the service you receive - all clients are entitled to the same high level of respect, care, professionalism, consideration.

That said, this whole thing is weighing heavily on my mind at the moment as my therapist charges very high fees and for the past 2.5 years, someone else has pre-paid my therapy fees for me (long story, which I won't repeat here in your thread!) So I am now at the point of not feeling ready to finish but not being able to afford her either. She has talked vaguely about us working something out for months - and I believe that that is her intention - but my last paid-for session with her is next week and we still haven't discussed practicalities and her new fee. If she doesn't then come up with a radically reduced fee that she is prepared to keep seeing me for, I'm going to be totally stuck. Trying to trust that it won't come to that but I guess all will be revealed next week as we absolutely *have* to talk about it then!

Not meaning to hijack your thread by talking about myself. Just saying that I understand how money stuff can change things/impact the dynamic. I have already had my weekly session length reduced from 90 mins to 60 mins from the start of this year (we didn't discuss and agree this - she just sort of told me in an email and I didn't push back) and I am wondering if she'll suggest fortnightly sessions instead of weekly (very unhelpful speculation based on nothing my part!) And I've had the same time slot in the diary for the past year or so and, since the start of this year, suddenly I haven't as she's obviously given my previous 90 min slot to someone else and my new 60 min time presumably fits better for her at a different time. And now we are sorting out next week's session time at the end of each session. Again - we haven't discussed this. She has just done it and I haven't pushed back or commented on it. And I don't like it.

So, what I really mean is, I am already finding myself thinking that, whatever she offers me, I must be grateful for it and just accept it. So, the impact of the finances on the dynamic is already kicking in big time for me. And hopefully once we've agreed whatever we agree next week, the certainty around that plan will make me feel more secure and then I can ask for things like a set time every week again and I think she will agree to do that.

If I feel at any point though that I am being treated as "less than", not as important, a lesser priority etc, that's a different thing to my stuff about feeling bad about not paying her "properly". And maybe she is already showing me that by messing around with my session lengths and times. But I don't think that is what's happening. We will see...!

Anyway...sorry...that was way longer and way more about me than I intended!
I really just wanted to express that I understand how the dynamics can change, I understand how it can be hard for us to work with a reduced fee (even if the reduced fee is what we need to enable us to keep seeing them and doing the work!) and that, if a therapist has offered and agreed to a lower fee, it is not on at all for them to operate a sliding scale service in line with that.

Good luck!

 

[DharmaGirl]

I know it's 100% her doing.

It's 100% your doing. She might have taught you some things, but YOU did it. You are stronger than you think.

She should not be sharing her problems with you. This is about you. If she is unable to keep up her appointments because of her trauma issues, she needs to take care of them on her own time, not yours. She is blurring boundaries and frankly I would ditch her. She is not a trauma therapist because she calls herself one.

I don't mean to sound harsh, but I had a T with complex trauma, and she was a bitch who diagnosed me with two things that my Pdoc said was not true at all.

 

[nomorechickenlittle]

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

I just went through a somewhat similar situation with my therapist. I was also a sliding scale and while i was one of the clients who was rebooked on a regular schedule for a few years later on it did begin to change. After awhile it became harder and harder to get appointments b/c he didnt know which other clients were 'moving forward'. I didnt get super assertive but i was able to tell him that i felt that i had to beg for appointments and that i was low on his list. It really wore at my self worth and i got tired of having to plead for appointments so the last one i just requested to book, he said he'd contact me the next week and he never did. I couldnt handle any more of it as it really triggered my self worth and rejection issues so i didnt contact him again. Perhaps pride but ive already mentioned on numerous times that i felt like i had to beg for an appt to which he responded that he didnt have anything to which i would note that he also wouldnt book anything. I had also told him for at least a year that by not being able to book appts i felt that he was 'firing' me Actually i've been in a pretty major depression since this first arose i think triggered by this whole thing. I feel really really hurt and it's really put my inability to trust in HIGH gear. I had a very abusive childhood where i was not valued at all and that was part of my therapy. Our last contact was mid nov and he's never called or emailed to see how i'm doing. I'm beyond devastated. i trusted this man. I allowed him to truly know me and look where it got me. I was/am in the same boat though. there was no other options for me. I cannot afford full price and it's very rare to find someone who will do a sliding scale.

 

[Eagle3]

Wow. My T does sliding scale, and I see him at the most discounted rate he offers. I always give him an extra $10, he puts it towards mat fees for one Aikido class with him a week as part of my therapy. So his full rate is $125, I see him for $65, and $10 goes for the Aikido class once a week. I can honestly say this man has never treated me with anything less than professionalism and care the entire time I've seen him (about 2 years now I think). All appointments are on time, we always discuss schedule changes before they need to happen, I have equal attention and access as all his other clients, etc. Money and power just doesn't seem to be an issue with us. I can see how that dynamic would affect people, its actually one of my hidden triggers that we might need to start working on soon. I would hate to have to deal with that dynamic on top of everything else!