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Therapy or Party?
October 19, 2011 9:16 AM   Subscribe

Did I just break up with my therapist? Am I being unreasonable?

I have been seeing a therapist for almost a year now. It's been going well, and she's really helped me explore the roots of a lot of the self-esteem and perfectionism issues I have. I go on a weekly basis; it's expensive, but we've managed to make room for it in the budget. I want to make really clear at the outset that I like my therapist a lot; sometimes I feel like she gets a little woo-woo about feelings and such, but I do think I've benefited from the therapy, and want to continue going, long-term.

Next year, my partner will have a milestone birthday, and I really want to throw a surprise party for him, inviting both current friends as well as old college friends he hasn't seen in years. I envision doing something really nice, probably hosted at an elegant but reasonable restaurant. Because I don't believe in asking people to pay their own way at this kind of event, I've really been struggling to figure out a way to make this a reality, given the fact that we are so careful with our money and have pretty much every last dime budgeted out. Plus, since it's a surprise I need to figure out a way to squirrel away the funds for this party without his finding out, and he's the one responsible for the finances in our household.

I thought I had landed upon a perfect solution: temporarily cut back my therapy sessions from weekly to bi-weekly. I never figured that my therapist would have an issue with this, especially since she had offered bi-weekly sessions as a possibility at the start of our relationship.

I was wrong. I initially raised the issue last week, and we discussed it quite a bit before agreeing that we'd both think about it over the ensuing week and talk about it more today. When she broached the subject today, I reiterated that I really wanted to go for the bi-weekly sessions. She kept trying to determine if there was some ulterior motive behind this move; she asked if it was because we were exploring some particularly painful stuff (it wasn't); she asked if it had anything to do with her seeing another patient right before me (definitely not); she asked if she had offended me when we discussed spirituality a couple of weeks ago (not at all). I have given this a ton of consideration, and as best as I can determine this really is just about me wanting to throw my partner a terrific party, nothing more, nothing less. It is a temporary sacrifice I’m willing to make because doing this for my partner means so much to me.

So then she basically told me that she didn't think it was a wise move, because all of the progress I've made so far would effectively cease, and also she would have to charge me her full rate (she's been billing me at a reduced rate because I come weekly), so in the end I wouldn't be saving much money at all. She didn’t put it like this, and I'm reasonably confident she didn’t intend it like this, but at the time it came across like she was implying that if I did anything other than weekly I shouldn’t even bother coming.

That felt like a gut punch, and I just crumpled (yay, abandonment issues). It was the end of the session anyway, so I paid her and gathered my stuff to leave. She wanted to discuss it more, and asked if she would see me next week, and I told her I didn't know and left.

It's clear she isn't supportive of the bi-weekly option, so at this point I'm trying to figure out what to do. As far as I see it, my options are as follows:

1. Disregard her lack of support for twice a month, go anyway, and expect to pay the higher fee. While this is technically an option, to me it's the least desirable, because I don't know how much progress I could make if she's already sort of obstinate about it, and I would be paying more per session.

2. Give up the idea of the party, and continue with therapy as I have been. While this may be good for me in the long term, I really feel hurt by what happened today, and my trust in her has been shaken a bit, and it would be difficult and awkward to go back as if everything's fine. Option 2a is to figure out a different sort of party for my partner, but even if I were to have a backyard cookout, I'd still have to find a way to pay for it, and I'm basically back at the starting point. And again, this is a milestone birthday; we both have had kind of a tough year (he's dealing with a lot of difficult aging parent issues), and the man deserves to have something really special.

3. Stop going for the time being. The disadvantage of this is obvious; I definitely cease making any progress. The advantage of it is that I achieve my savings goal much faster, I could resume going full-time sooner, and it allows for a cooling-off period. But that also raises a similar disadvantage as listed in #2, in that I don't know what the tenor of our patient-therapist relationship is going to be after the drama of today.

4. Stop going for good. This, to me, is no more a desirable option than #1.

I really need some gentle perspective on this, as I'm still too close to the events of today and I'm all weepy just typing it up and reliving the conversation. Throwaway e-mail is therapistorparty@gmail.com.
posted by anonymous to Human Relations (32 answers total) 2 users marked this as a favorite
 
Dump this therapist!

Hon, you made all of that progress. You did all of that hard work. Not her.

Anyone who tells you that you need them, specifically, in order to achieve xyz goal in your life is someone you should run from. Especially when you must pay for the privilege!

Also. Read back your question. It sounds like she is more interested in your money than in you, personally.

DTMFA. RUN.
posted by jbenben at 9:23 AM on October 19, 2011 [35 favorites]


I think it's a big red flag that someone who is supposed to respect your boundaries and shepherd your emotional growth was so pushy and frankly, manipulative with you. If you've been seeing her for a year, she should know that you'd react poorly to this kind of communication. If you feel comfortable doing so, I would bring it up with her at your next session and explicitly tell her how her behavior made you feel. If she's worth her salt as a therapist, this will engender an honest and helpful conversation. If, however, she's more concerned about her paycheck than your well-being, then you may be better off with a different therapist.
posted by Lieber Frau at 9:24 AM on October 19, 2011 [6 favorites]


Others might give you a more nuanced response, but my gut reaction to this is to drop her like a hot potato.

1. She's running a business and needs to make money like you, she's protecting her interest by having you come in once a week and will compensate that by charging more if you decide to come in less. She is going to get what she needs from you regardless.

2. Have some faith in yourself. Do you really think that you will absolutely quit making progress without seeing a therapist for a while? If your mental health is reasonably ok, why don't you try taking a break from it?

3. Your relationship is indeed going to compromised by this obstinance, she's shown her hand so to speak. She has been helping to guide you and has had an evident impact on your life, but it may be time to let this relationship go and take what you learned and do what you want.

So yeah, make some money, take some control, and throw your man a kick ass party.
posted by stormygrey at 9:25 AM on October 19, 2011 [3 favorites]


I'm a therapist.
I would recommend terminating with your therapist. #4 She may be right in her clinical judgment (I have no idea), but it doesn't feel right to you. Are you going to trust her enough to continue doing the work? Seems doubtful to me. It appears that rapport has been lost. Yes, it can be regained, but in my experience it won't be regained in bi-weekly sessions (too long in between means the work tends to drift).
Here's what I would do in your shoes:
I would terminate with this therapist, be vigilant in my own mindfulness of how I was approaching the world and relationships, then after the party, pick up with a lower-cost therapist. If money is an issue, don't make affordability part of your therapy. Use a therapist you can afford so that subject can be left at the door. Ask around for recommendations for a good quality low-income agency. They do exist in large cities.
posted by johngumbo at 9:25 AM on October 19, 2011 [5 favorites]


Hi. I'm a therapist. I think your therapist is being a jerk. I'd suggest you go next week and discuss these feelings with her. She should be trained to not take it personally when you tell her how her response impacted you. (it sounds like she did take it personally, especially if you mentioned you needed the extra money for a party.) If she can't adjust her approach after that, you should terminate.
posted by pineappleheart at 9:26 AM on October 19, 2011 [5 favorites]


I do not think your therapist acted well at all here. It's possible you misunderstood her motives, it's also possible that she is disrespecting your boundaries and, thus, you.

That said, though, and separately, I think it's a terrible, terrible, irredeemably bad idea to literally sacrifice your (mental) health so you can throw your partner a birthday party. Presumably, he's more interested in having a healthy partner than in having a birthday party that the two of you can't afford, and necessarily involving financial deceit. If you think that going bi-weekly will be worse for your mental health than going weekly, then this is a really, really bad idea. Scrap the party, spend time instead of money finding some cheap/free awesome stuff you can do together to still make the day special, and keep your mental health.
posted by brainmouse at 9:26 AM on October 19, 2011 [3 favorites]


dump her at once
posted by 3mendo at 9:30 AM on October 19, 2011


This is just weird. If I told my shrink I was having money issues for awhile and needed to cut down, she'd understand. What did you tell her that you wanted to cut down sessions for, anyway? I kind of don't think you said, "Look, I need to save money for a giant party for a few weeks, so I need to pare back" exactly if she keeps asking why you want to cut down.

That said, if your only reason for cutting therapy sessions is to throw a giant party, I kind of agree with brainmouse. I also don't think you HAVE to have the nicest of nice parties at a spiffy expensive restaurant at which you treat for everyone to have a nice day. Why not just throw a house party with the help of friends?
posted by jenfullmoon at 9:32 AM on October 19, 2011


Oh, yes. And this...

I've been to plenty of therapists. The professional thing for her to do was to accept your proposal, or simply refuse if the rate you can afford doesn't cover her expenses. But in no way should she have used her authority to guilt you into going against your decision.

Every entreaty to "keep talking about it" was an attempt on her part to talk you out of what you wanted to do. I don't believe any therapist has a right to do that. Ever.

If I were you, I'd leave her a voicemail when I knew she was busy thanking her and telling her that I will get back in touch if I want to try therapy again. And if she phoned back, I would NOT pick up the phone.

I'm sorry. It sounds like you did some good work in her office. But since it was really you who did all the work, you can keep doing that elsewhere.

---
---

Good luck! You'll keep up with the self-improvement.

I think the way you handled this proves you are doing really really well, FWIW.
posted by jbenben at 9:36 AM on October 19, 2011 [3 favorites]


5. Ask people to chip in for the party.

I'm not saying this is necessarily the best option, but it's one you haven't seemed to consider. As a guest, I wouldn't think it weird at all to pay for my own food at someone else's birthday party.
posted by desjardins at 9:44 AM on October 19, 2011 [1 favorite]


One of the things I've noticed is that too many therapists try and force your issues into practical discussions about the therapy. they are trying to help you by using your relationship to them to highlight things about your past relationships. All well and good, but it can make for a tough time when you make practical changes. They're just dying for it to be about your issues, even when it isn't about them at all.

You just have to deal with it.
posted by Ironmouth at 9:47 AM on October 19, 2011 [5 favorites]


I may disagree with your therapist's delivery, but I kind of agree with her point. Stopping therapy (and you're now considering this, because it sounds like going bi-weekly is not going to work out, budget-wise) to throw your partner a party, even an awesome party, is unwise. Yes, you did all the work in therapy, but the therapist is your facilitator here. That's why therapy is therapy and not motivational self-talk.

Now, I understand that your trust in her, specifically, may have been shaken. You felt pushed and sucker punched when she reacted that way to something that, in my eyes as well as hers, sounds pretty self-sabotaging. You should drop her if you don't think you could be comfortable around her any longer. BUT. If you decide to drop her, you should find another therapist, preferably by the time your appointment would have been next week, and go weekly from that point onwards.

Therapy trumps parties. The two of you have made room in your budget for you to go to therapy, not for you to throw him parties, even milestone birthday parties. It is entirely possible that your partner might not appreciate the gesture as much as you think. You skimping on therapy is not a sacrifice for you alone, it's potentially a sacrifice for your relationship.
posted by lydhre at 9:49 AM on October 19, 2011 [22 favorites]


I could see the change from the reduced rate--if that were laid out in the discussion of policies, etcetera. I'm also not sure about changing up mental health care for a party.

HOWEVER. I think you have learned something valuable about your therapist. This would have been a good point to reiterate what and why her rates are set as they are. Have the practical discussion, as Ironmouth mentions.

It also might have been a good point to explore your idea of what this exact party would mean to your partner versus what you think will happen when you tell him how you could afford this. Individuals are different, and perhaps your partner would be touched. I would feel sad and angry to learn this. It would affect my memory of the nice time to know that my partner had made this particular sacrifice. It would be like "Hey, I didn't eat for a week and that's how we can afford a party!"

The biggest and most challenging gift I have given to someone I love is active continuous management of my mental and physical health. Self-care is a gift to the people who love me. But active self-care does not meet my internal expectations of giving those people the nicest and best and most perfect X I can manage. And that is something I am working on in therapy.

So while I don't have a great answer for you about this conflict and changing therapists, I can tell you about what happens when "things I gave up for X perfect event/thing" meet "my partner's love and the resulting relationship-straining fight." I've learned that this sort of gesture may appear to assume something unkind about my partner, and they may not appreciate it the way I thought.
posted by Uniformitarianism Now! at 9:58 AM on October 19, 2011 [2 favorites]


I think that repairing a relationship with a therapist after a breach like this might actually be very good for you--or at the very least, explaining how you feel and why instead of just leaving it hanging.

You don't have to go back as if "everything is fine", you can go back and tell your therapist that your trust has been shaken, and why, and that it triggered your abandonment issues...and see what happens.
posted by the young rope-rider at 10:08 AM on October 19, 2011 [2 favorites]


Independent of what your therapist is telling you, do you believe that cutting the therapist to half-time, or cutting therapist out altogether, will cease the progress you've made?

I'm going to allow myself, as a devil's advocate, to take what the therapist said to you charitably. Here we go:

Does your therapist have any basis, considering what you have done in therapy so far, for thinking you have that you have an ulterior motive due to exploration painful stuff, her having a patient right beforehand, or being offended when discussing spirituality? I mean, are these issues that you have brought up in the past as related to other people?

By the way you phrase your question, it seems that these accusations by your therapist come from left field. They very well might! But since you've been with her for so long, and she's been effective, maybe you should think about it. They might be valid questions for therapist to ask.

Also, being charitable again, was therapist's telling you the price difference really just full disclosure?

You state that you have abandonment issues, which indicates that you fear abandonment, so you probably have safety mechanisms in place. Is your therapist worried that you are ditching her because of these safety mechanisms?

Okay, that was me going against the grain. I think you should trust your gut (to the extent you think your gut can be trusted). If you no longer trust your therapist, and if it is justified, then find a new therapist! If you think you can discuss these issues in your next bi-weekly session with her, maybe hash them out, maybe it will be good for you. So, consider having one more session with therapist before making a final decision of breaking up (but stick to your guns about bi-weekly sessions). Just keep in mind that you are the one that needs to be convinced, not your therapist.
posted by jabberjaw at 10:16 AM on October 19, 2011 [1 favorite]


Did you explain about the party and money issues? I may be reading incorrectly, but it seems as though you asked to cut back to bi-weekly but didn't explain why. I don't know how I feel about her reaction, but perhaps when you go in next week explain everything that you've written here. Make sure to tell her:

1) You appreciate the discounted rate. You feel that you've come a long way and that you wouldn't have been able to afford it otherwise.

2) The reason you asked for a bi-weekly meeting was not to sacrifice your mental health. You were trying to plan a nice party for your boyfriend and just wanted to make ends meet. You had forgotten that/were unaware that her rates would increase.

3) The conversation last session really triggered some things for you and you felt that you really checked out of therapy with this therapist. You aren't sure why.


When your emotions tell you something, you should generally listen. If you don't feel comfortable with this therapist, that's fine. However, I do think you should ask yourself if your discomfort came from a reasonable place or if it came from old patterns that you are trying to work on. If you find yourself fleeing at any conflict, maybe you should rethink your gut reaction. This may have been a normal conversation that caught you at an emotionally vulnerable point.

I also do not think it is the best idea (although very, very, very sweet) to sacrifice therapy for a party. I understand that you want to make the party amazing, but you should put your health above this. You will be cutting back for a whole year! That's a lot. If it were for a month, that'd be a little different. Maybe you could get a part-time job (here is a rolling internet one that pays $14.50 an hour, you can do at home on your own hours, you only need to work around 10 hours a week, and is very easy to get hired for). I do think you should learn to put yourself and your mental wellness before anybody else--even a dear partner. Knowing that her/his partner has been getting more and more comfortable with themselves would make anybody much happier than a huge party. Like I said, there are other options.
posted by 200burritos at 10:28 AM on October 19, 2011


It's the therapist's clinical judgment that you should be in therapy weekly. She would not be doing her job if she didn't tell you that. Especially since the reason you provided seems flimsy. Money issues is one thing, but this is a unnecessary (and perhaps unwise) money issue of your own making, which So I don't think it's strange that she's looking for an ulterior motive.

The problem is that, of course, the therapist also has a financial interest in seeing you weekly. In medicine, you would be able to deal with the financial conflict of interest by getting a second opinion from someone else. You can't do that here easily, since another therapist would need several sessions in order to evaluate you. So the second opinion will have to come from you.

Do you feel like you would benefit more from going to therapy weekly than biweekly? If so, then you should go weekly. If you feel you can't trust this therapist anymore, you'll have to find another one, but I think I would try this one out for at least one or two more sessions. If you don't feel that weekly sessions are really benefiting you that much more, then by all means, switch to biweekly.

Additionally, if I were your partner and we had agreed to manage our finances as a household, I would be pretty upset if my partner took money that we had agreed to allocate for legitimate medical needs (which your therapy is), and had been diverting hundreds (or more than a thousand) of dollars to pay for a party, even one ostensibly in my honor. Perhaps you would like to have more money to yourself outside the purview of your partner? I think that's a reasonable thing to want, but this is not a good solution.
posted by grouse at 10:32 AM on October 19, 2011 [2 favorites]


So then she basically told me that she didn't think it was a wise move, because all of the progress I've made so far would effectively cease, and also she would have to charge me her full rate (she's been billing me at a reduced rate because I come weekly), so in the end I wouldn't be saving much money at all. She didn’t put it like this, and I'm reasonably confident she didn’t intend it like this, but at the time it came across like she was implying that if I did anything other than weekly I shouldn’t even bother coming.

It's really hard to tell here what she actually said; and how you heard it; and how she heard you; and how accurate her assessment of your "progress" is. To see it in the light most charitable to your therapist, you just told her that you're going to trade your mental health to throw a party for your boyfriend. Seen that way, one can understand her concern.

That said, the financial constraints of therapy are real and form part of the whole picture of how therapy should work for you. If this therapy is such a strain on your budget, you may need to try other alternatives. Personally, I'm skeptical of therapies that require an endless committment to talking through your problems; as well as any therapy that claims that you'll backslide if you leave. Good therapy should be about developing tools to deal with life's challenges, that you can eventually apply on your own. There may be some value to talking things through on a weekly basis and exploring your background, but that can't last forever. In short, in good therapy, you should be able to take a break without causing problems, because the goal should be for you to be able to improve your independant functioning.
posted by yarly at 10:33 AM on October 19, 2011 [4 favorites]


Oh, also -- in the very early stages of therapy (first 1-3 months), then I can see why weekly continuity would be very important as you get to know each other and develop momentum. But after a whole year, this seems less important.
posted by yarly at 10:35 AM on October 19, 2011 [2 favorites]


I agree with two hundred burritos (although not sure re internet work)- it's possible you didn't state your reason clearly enough and that was why the therapist was trying to dissuade you. Why would she keep throwing out reasons if you already told her the reason why you wanted to cut back. Anyway, regardless, don't quit until you have someone else lined up, if you quit at all, and seriously reconsider an expensive party that is above your means. Gathering friends is wonderful- it doesn't have to cost a fortune and people are often asked to chip in for restaurant dinners (in nyc anyway, ALL THE TIME!).
posted by bquarters at 10:59 AM on October 19, 2011


How temporary is temporary? It's more than two months until 2012. And if your boyfriend's birthday is any later than January, I can see your therapist objecting to going to biweekly, especially as you are dealing with heavy stuff.
posted by nooneyouknow at 11:11 AM on October 19, 2011


Yeah, my therapist and I dealt with this at various times, even going up to cheaper-per-session twice weekly for awhile (Tough, but more than twice as effective), then back down to weekly. I wanted to jump ship at the first sign of conflict (and was sure she was dumping me, and if she wasn't, I should do it first), but she asked me to stay with it, to try to make it work with her, and I'm so glad I did. I would guess it's not So much about the money as her sense for your therapeutic needs. But she didn't convey that to you well, so let her know what you Heard.

It's gonna suck, but I say at least go next week and talk about this a bit more. She wasn't trying to abandon you, do yourself the favor of not abandoning the process, either, without at least one more session to talk about this stuff.
posted by ldthomps at 11:21 AM on October 19, 2011


I think that even if you decide to seek out therapy with someone else--and that would be a legitimate decision, given what happened--you should do one more session with this therapist.

You've said that you have abandonment issues, and issues with self esteem and perfectionism. If you feel like she has abandoned you and you don't give her a chance to address that--not for her, but for YOU, then you are reinforcing your own abandonment issues. Presumeably if you have abandonment issues, there have been significant people in your life that you feel have let you down, or left you unexpectedly, or betrayed you. And I'll make another leap and say that when those things happened, you probably did not see them coming and had no idea what happened to make the other person do what they did.

So, looking at it through that lens, you're telling us that you feel abandoned, that you really felt secure with this woman and her actions now conflict with that, and you don't really know why or what to do next. Abruptly stopping therapy now and not talking to her anymore doesn't address any of your questions about why this happened. If you go back next week, you can say, "When you said X, I heard Y, and now I am feeling Z. When you said X, did you really mean Y? Can we talk more about why you said what you did?"

Maybe the discussion will help you feel more secure and you will decide to proceed with therapy with this woman. Maybe the discussion will help you realise that you don't feel comfortable with her and you want to terminate the therapeutic relationship. Either way, you'll have some closure, and hopefully fewer feelings of abandonment.
posted by catwoman429 at 11:43 AM on October 19, 2011


I'm a therapist.

1) We have no idea of the clinical implications of a move from once a week to every two weeks. No one here does. It is certainly your therapist's job to inform you of her opinion as to the possible impact of changing the timing of your sessions. This is part of what you pay her for.*

2) We have very little idea of what went on during your session. Not only is your language non-specific, but you seem to be clearly presenting your reactions to the things your therapist said, rather than what she actually said. Maybe she handled this badly, maybe you handled it badly, probably it was a combination of the two. Certainly your therapist should want to work through this with you, and she has in fact asked to see you next week. If you decide not to see her, that is certainly not her fault alone.

3) It's reasonable, and standard, for your therapist to change her adjusted fee based on how often you see her. This is something I negotiate with patients all the time. Think of it this way: she is very unlikely to fill that timeslot with someone else who wants to see her every other week. You are effectively taking up that hour every week whether or not you go every week. If you're paying full fee, this should not be an issue; but if your therapist has adjusted the fee based on the expectation of a weekly slot filled then it is legitimate for her to adjust her fee upward if you reduce your use of her service.*

4) Part of therapy is making a choice about how important it is to you. We measure importance in all kinds of ways: time is one, money is another, willingness to brave discomfort is a third. It's unclear whether you told your therapist why you want to cut back on sessions. If you didn't, then your therapist was essentially correct that there is some ulterior driver of your decision making here, even if that is not a clinical reason. (Although, depending on what you two talk about, this reason could certainly be considered clinical.) If you did tell her, what you were essentially asking, asking in practice, is that your therapist pay for your husband's party. You did this because of your expectation that you could reserve your therapist's time (see above on why you're really taking the weekly slot) for half the amount of money.

Now, all of those things may actually be beside the point. Your therapist may not have handled this well, you may feel betrayed and unable to work with her. You may end up feeling like therapy is less important than this party, and that might be a good thing. Therapy should help you to do things in life, not just get more therapy. Maybe you need a break, maybe you need a new therapist. Maybe you'll return to therapy later, perhaps you won't. But I don't agree with some of the petulant responses here that make it seem like your therapist is a bad person or a bad therapist because she didn't immediately acquiesce to your request to effectively fund your husband's party. (DTMFA, really?) The point is that this is a moment when you can and should evaluate what's important to you, and make a decision based on that. You might find that stopping therapy, even if it seems like something you're upset about now, was the best decision you could have made. Even if it isn't you can always find another therapist. (yarly's comment above is quite good.)

*Therapists make their living by providing therapy. This does present a conflict of interest in some respects, because it's always better to have a full slot than an empty slot. This is a good reason that patients need to have a good sense of what they want to get out of therapy so that they can work toward it and hold their therapist to account. But the cost of therapy is only vaguely under the control of individual therapists, who do not set rent prices, health insurance prices, mortgages, tuitions, food prices, the reimbursement rates for insurance-paid mental health care, or parity policies for mental health coverage. Despite all that, many therapists offer a sliding scale, and many work at least part time in agencies offering low-cost mental health care. Frankly, the suggestion above that "It sounds like she is more interested in your money than in you," is offensive. She's already offered a sliding scale in this instance, it's entirely unclear why she should be considered a villain for refusing to further reduce it simply because the OP wants to fund a party. Can you imagine folks suggesting that a plumber was a crook because, having already given a discount, they refused to do half the work for free? It's up to each individual to determine how much they value the therapy, that means both the therapist and the patient get a say**. The patient is always free to walk away, that doesn't get them deemed villainous, nor should it.

**There’s actually a fair amount of clinical writing about the relationship between money and therapy, and certainly about the sticky situations that people get into asking for money or asking for discounts as it pertains to therapy. The general gist of it is that insofar as therapy is frequently predicated on a kind of intimacy, and specifically on a kind of caring intimacy, there are very few conversations about payment for services (in either direction) that do not have clinical content. One can see some vestiges of this in what I see as the general AskMe attitude about therapy, which is that it is both necessary, and too expensive (with the predominant implication being that therapists are making out like bandits). Even with respect to professions that demand a much higher hourly payment (lawyering, doctoring, plumbing), the tone of discussion is, at least to my ears, much different.
posted by OmieWise at 12:33 PM on October 19, 2011 [20 favorites]


You've gotten a lot of good advice so far, so here's something else to think about: If you were my partner, it would make me feel terrible to know that you had forgone medical care in order to throw me a party, even though you seem fine with cutting back the therapy and enthusiastic about the party. Knowing this (even if only after the fact) would really sully things for me.
posted by kitty teeth at 3:17 PM on October 19, 2011 [2 favorites]


When I was seeing my therapist, the most valuable thing she did in our sessions was to ask questions that I hadn't thought to ask myself. (For example: "Could you ask your family for help?") Thinking about the question she'd asked was usually helpful, and thinking about why it hadn't occurred to me to ask the question was always helpful.

Whether you do it with this therapist or find another one and do it with them, there are a number of aspects of this situation I think it would be useful to explore, like:
posted by Lexica at 3:41 PM on October 19, 2011 [2 favorites]


I'd like to favorite OmieWise a dozen times. Why therapists are expected to work pro-bono is beyond me, but the suggestion that this therapist, who did the OP a favor by already dropping the rate for her, is interested in only the money, is absurd. Therapists have to earn a living, too, and she has the right to refuse to maintain the sliding scale if frequency of sessions drop. OmieWise is right - it is not easy to find someone else to take a biweekly spot, so she loses an hour a week of work every two weeks.
posted by namesarehard at 7:04 PM on October 19, 2011


I don't think the OP expects her therapist to work for low or no fee!

The problem seems to be the OP feels subtly bullied by the therapist. Obviously, I agree in my answers above, but the folks who bring up abandonment issues make a good point. Personally I don't believe in further entertaining anyone that takes advantage of you, and since the OP discussed this issue with her therapist TWICE, I feel like that was enough of a chance for the therapist to make herself clear.

The OP is not foregoing medical care, she is involved in a voluntary process of personal growth and self-improvement.

Furthermore

In every therapy scenario, excepting involuntary commitments, the client has the ultimate right to be happy with their (100% autonomous choice) of therapist and modality. It is not for the therapist to use guilt. State their concern or position? Sure. But no therapist is in the omniscient position to say, in any way, that if you don't stay with me on a weekly basis you will lose all of your hard work. That's just bunk.

The OP could easily quit therapy and pursue a spiritual path, or take up journaling, or go on regular nature walks and adopt meditation, or try bio-feedback, or binaural beats audio mp3's, or self-help books... I could go on. There is no rule that says, "Talk therapy is the only way forward." Full stop.

- It would have been nice if the therapist had declined a new financial arrangement, and instead spent the last few sessions discussing how the OP might maintain her progress, help the OP formulate a reasonable plan based on the OP's stated criteria.

- Where and how the OP spends her money is NOT any of the therapist's business when it comes to the OP's decision to spend her money on therapy or not.

- Again, it would have been nice if the therapist could have said, " I'm sorry. I can't see you for X amount of dollars for the foreseeable future because it is below what I need to make to pay bills/rent, but please call me if your situation changes. Here is a list of low-fee clinics if you end up needing that."

And repeated for truth...

- It would have been nice if the therapist had declined a new financial arrangement, and instead spent the last few sessions discussing how the OP might maintain her progress, help the OP formulate a reasonable plan based on the OP's desired criteria.


The therapist is a contracted and at-will player in the OP's long-term goals regarding well-being. There are thousands of ways to achieve well-being.

I think the OP rocks for seeing a professional boundary was crossed. Considering the length of the relationship, the OP could go back and try to repair the relationship in some fashion, but after two tries of stating her case, I think she has fulfilled any obligation she has towards herself to handle things maturely.

So if you are OK with it OP, go ahead and give it a third try. Just please don't go there out of guilt.
posted by jbenben at 11:37 PM on October 19, 2011


jbenben, your presentation of events is so far from what we know (and we already know precious little), that you might want to reconsider your certainty.

The therapist here did not suggest that the OP would "lose all [her?] hard work." Neither is she telling the OP what she can spend her money on (no on in the thread is either).

Here's what the OP wrote:
So then she basically told me that she didn't think it was a wise move, because all of the progress I've made so far would effectively cease, and also she would have to charge me her full rate (she's been billing me at a reduced rate because I come weekly), so in the end I wouldn't be saving much money at all. She didn’t put it like this, and I'm reasonably confident she didn’t intend it like this, but at the time it came across like she was implying that if I did anything other than weekly I shouldn’t even bother coming.
This is a very different set of responses from the therapist than you have characterized them as. First, we see that the therapist offered her clinical impression about what the result of switching to a reduced schedule would be. No part of that clinical impression involves devaluing the OP, the hard work that they've done, or what they've accomplished. As characterized by the OP, the opinion only concerned future work. Second, we see that the therapist reminded the OP that they have a financial arrangement, beneficial to the OP, predicated on a once weekly session. No one is trying to abridge the patient's choice here, but surely the patient should have all the facts before making a choice, especially those financial facts that seem most germane to her decision. Third, we see, as someone else pointed out above, that the OP is presenting her reaction to this discussion, rather than the actual content of the discussion. In other words, we know that the OP felt badly, that she began to feel rejected by the therapist, but we have no idea what the therapist said. Not only that, the OP describes herself as having "abandonment issues," which certainly in this context, and as presented, raises the possibility that her emotional reaction does not tell the full truth about the conversation. We certainly don't have enough information to suggest that the therapist was trying to "guilt" the OP into staying in therapy, or was acting in any other way unethically.

So why is this important? It's important because we essentially have no idea what's going on here. We have no idea what the content of the therapy has been like, what the state of the OP's marriage is like, what the meaning of a party like this might ultimately be. We don't have any real information about the OP's general state of mind, or the predominant set of issues she has been addressing (we know she's identified self-esteem and perfectionism, but that's all we know). In short, we have no basis for forming a certain judgement about what the OP should or should not do, or what the therapist has or has not done. Indeed, I can easily think of scenarios in which throwing this party (which we don't even know if the therapist knows about) would be a disastrous idea for someone, and where, if we knew all the facts, we would be urging the OP to stay in therapy.*

What we can do is to point out the places in the story where, if not unreasonable, the OP's story seems to be particularly one-sided. We can give her the benefit of the doubt, not only in this story of the moment, but in her assessment that her therapist has been helpful and that she likes her. jbenben's first comment was absolutely correct (before it went off the rails) to point out that the progress the OP has made is her own, but what that means in practice is that the best help we can offer her is to flesh out the information she has to work with so that she can make her own decision. It's presumptuous in the extreme to think that we know the answer to her question about how she should handle her own therapy and how it intersects with her life. (Isn't that what the therapist is being castigated for supposedly having done?)

As I said in my first comment, this is a choice the OP has to make. Her therapist is not preventing her from making the choice, and would be completely reasonable in adjusting her reduced fee based on a change in the frequency of session. That's part of the choice the OP has to make. I have confidence that the OP can make that choice for herself.

*One can easily imagine an AskMe, for instance, in which a poster describes being subtly pressured, by a semi-emotionally abusive husband, to throw him a party despite no money for said party. The poster's only solution (because the husband does not believe in asking others to pay in this type of situation) is to curtail the therapy that has been helping her to deal with her difficult marriage, and perhaps gather the wherewithal to leave it. We don't have any reason to believe that's really what's going on here, and I'm not suggesting that it is (and certainly not trying to upset the OP), but that's only the most lurid kind of example of a situation that might look similar on the outside but be very different on the inside. My point is that we have no idea what's really going on here, so we should err on the side of respecting the OP's need to make her own decision.
posted by OmieWise at 5:26 AM on October 20, 2011 [1 favorite]


jbenben -- I agree with you. This therapy is a voluntary activity undertaken for the purpose of self-improvement. It could be a meditation retreat. It could be a box of self-help books. Or bodywork. Or, well, anything else that might help. The therapist crossed a boundary here, and I get a weird gut feeling about it.
posted by metametacap at 7:20 AM on October 20, 2011


Hi, it's the OP. Since I managed to raise more questions than I got answered, I figured it was worth the $5 to not have to funnel answers through one of the mods.

A few points of clarification, since I think some of the assumptions made about me and my therapist have been pretty uncharitable and/or assuming the worst about the people involved, but at the same time, I take a good amount of responsibility for that, since I was trying to be succinct and not provide a quazillion side details and anticipate every possible argument:

1. My partner is my spouse, not my boyfriend. We have been together for almost two decades. We have a terrific marriage. He is incredibly supportive of me, very respectful of me, and doesn't bug me about therapy. I know he is more than willing to discuss anything I might want to talk about, but since I usually keep that part of my day to myself, he's also just fine respecting that boundary. I mention this last part because these last two days have been really hard, and he's the first person I talk to about hard things, but, because of the nature of the matter, he's the *last* person I can talk to about this particular issue.

2. Please don't denigrate my wanting to throw him a party, or regard it as some sort of frivolous desire. Both of our lives have been touched by several deaths recently, including a situation where I myself faced a very serious health scare (with hospitalization) that could have taken my life. I am under 40 and have a child with him, so this was particularly frightening for all of us. He has borne so much over the last few months, and that, coupled with the aging parent issue I mentioned in the original post, and the general bit of sadness that most people experience as they approach a milestone age, makes me want to do something really special for him.

We host events all the time. We love to have people over, everything from intimate dinner parties to bust-down-the-doors-invite-all-the-neighbors BBQs, so I know all about what it takes to put together a party. They're always more expensive than you think, and they require a tremendous amount of work before, during, and after. I am certain there's no way I could handle it by myself without tipping him off. And again, the key here is surprise party. He's never had a surprise party thrown for him. He's recently reconnected with several of his old college friends whom he hasn't seen in over a decade. They are far away, but I've quietly reached out to them and they have each said that they would absolutely travel here to celebrate with us.

Having been together for nearly 20 years, I also know my spouse well enough to know that he would not be upset, angry, or hurt by my doing this for him, even with the sacrifice it would take to make it happen. If anything, he'd be thrilled that I figured out a way to do it without putting us in debt.

3. Therapy is important to me, and something I want to keep doing for the long-term, but I am not emotionally unstable, suicidal, or in a dire mental state where to stop going for a period of time would be hugely detrimental to me and anyone in my sphere. One of the things I've been working on is not regarding it as a luxury, but... it kind of is. And I'm acutely aware of it. I'm aware that there are people who have far more serious issues than I do, people who need therapy way more than I do, and yet I get to go because my circumstances and privileges enable me to go. Not going for a period of time would be a sacrifice for me, but, given all that I've explained above, a worthy one.

For me, therapy right now is sort of like converting a house with crappy radiators and window units to full-on central heat and air. The current arrangement isn't a good one, and has been there for years, and the ultimate goal makes everything work a lot better. But if something came up that mandated scaling back on the project for a couple of months, then I'm willing to go through one more winter with clanking pipes. I've dealt with my myriad issues for this long, I am strong enough to deal with them for a bit longer.

4. I was hurt by what my therapist said, but I've been given a lot to consider here, and I fully acknowledge that the part about "not even bothering" was what I inferred, not necessarily what she was implying. I was really upset at the time, so don't remember her exact wording, and I apologize for not being able to give you a verbatim account. If my therapist made any mistake here, it's that she waited until the end of the session to bring up the subject again, rather than discussing it from the beginning. At the same time, I don't think she anticipated I would react so poorly, just like I didn't anticipate she'd disagree with me.

5. Yes, she knew from the beginning why I initially proposed scaling back to bi-weekly. I was very upfront with her about my reasons from the very first time I mentioned it, which is why her probing to find if there were other motivations bothered me, because it really felt like she didn't trust me that I was being completely honest with her. I have never given her a reason to not trust me in previous sessions. I have been nothing but honest, transparent, and forthright in our sessions, even though it's meant talking about some really difficult and often embarrassing stuff. The specific issues she raised definitely came from left field, and were not anything that has ever bothered me in the past.

6. I like my therapist a whole lot. I respect her. I do not feel bullied by her; I feel that what I wanted to happen with this situation came into direct conflict with the realities of the monetary and scheduling aspects of being a therapist. I didn't consider it from that angle, and I'm grateful for those who have pointed that out. I really don't want to find a new therapist. As anyone who has been through therapy knows, it's a crapshoot to find a therapist you really like, one who gets you, and even when you do, it's tough and exhausting to build that initial foundation, and I do not want to go through that again.

7. The party, if I threw it, wouldn't be until mid-2012, but I'm a planner and like to have things in order well ahead of time. So yes, 2012 is still two months away, and my partner's birthday is even farther out, but I don't want to dither over this for months at a time. I need to put a plan into action now so I'm not driving myself crazy next summer.

----

I still don't know what to do at this point. She called me yesterday (I was in a meeting at work, so I couldn't take the call) and left a nice message, and asked if she would still see me next week. I need to call her back today, but I don't know what to say. In all likelihood, I'll go back next week specifically so we can talk about it.

I am grateful for the many perspectives here, and most especially for the information provided by OmieWise on the other side of the couch, so to speak.
posted by stocking marionette at 8:03 AM on October 20, 2011


It's nice to see all this additional info. It actually makes me more convinced that you have considered a lot here, and that you can make a good decision (a decision that is right for you, right now) about this. Two things struck me about what you wrote, although I'd stress again that you're the expert here and even with your clarifications I don't feel like I know too much about what's going on.

1) There are solutions that you didn't mention, but that might meet your needs. You could say that you want a hiatus for a while, but would like to have a check-in session once a month. Or something of that nature. This is something people often do when terminating therapy, but it is also something people do to bridge a gap.

2) I have to stress again that I really don't know what's going on between you and your therapist, but I wonder if part of what has you so upset here (and really, this is just speculation on my part) is that despite everything you just outlined here about why this party is very important to you, your therapist doesn't seem to be understanding that in some way. She may be saying the right things about it (I don't know), but her questions may make it seem like she doesn't understand what's really going on here for you, the calculations you're making, the sacrifices you are contemplating, even the sacrifice you are already making to afford therapy. If that is part of what's going on, that is certainly a conversation you should have with your therapist, and that she should be able to engage in. These kinds of failures of empathy can actually be good for a therapeutic relationship, as long as your therapist handles a discussion of it well.

Best of luck with all this. I'm sure it will be a great party.
posted by OmieWise at 8:33 AM on October 20, 2011


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