My therapist stresses me out. Should I switch?

January 4, 2011 7:01 AM

Is it appropriate to discuss with my therapist why he stresses me out? How do you switch therapists? Do I need to?

I love my therapist and have been seeing him for a few months now. I've seen many, and he is very clearly the best one I've ever seen - I feel like we've built a great relationship and he really "gets" me. However, there are two big problems: He's on the other side of town, and he is disgustingly expensive.

I work full time so I have to see him during evening hours, and it is extremely stressful getting to his office during rush hour traffic. I often do not get home until 9pm. If I schedule earlier, I would have to leave work early on a weekly basis and I do not want to explain to coworkers why I am leaving early. Sometimes I do leave at 4 or 5pm for an earlier appointment, and my boss probably thinks it's because I just feel like leaving. This stresses me out because I do not want to look like a bad employee. (HR is out of the question - our HR employee is not helpful or private or particularly nice)

When I started seeing him, my parents were supporting me by paying for sessions. Now that I moved out of the house and closer to work, I am paying for them on my own. He is not on my insurance plan and he overcharges more than anyone I've ever heard of. My parents are encouraging me to find a new therapist closer to work and on my plan but I am mortified by the idea of starting over, of having to retell my entire story, and developing a new relationship after everything I've worked so hard for with my current therapist.

Are these things that I can discuss with him? I don't really know what I expect him to do, it's not as though he's going to move closer to my office or lower his prices. Do I start searching for/trial sessions with a new therapist without telling him? Do I ask him for referrals that are in the area?

Again, we have an excellent relationship and I feel like he's the first therapist I've ever seen who I can really connect with. It's just so much time and money.

posted by anonymous to Health & Fitness (17 answers total)

it's not as though he's going to move closer to my office or lower his prices.

Sure, his office will still be in the same place, but lots of therapists work on sliding scales. It is definitely worth it, and you owe it to yourself to have a conversation about this. If he can help, he will. If he can't, he may be good in recommending someone closer to you/on your plan.

Try not to worry about what's going to happen when you have to switch therapists right now (telling your story again, etc). You're not even there yet, and for all you know right now, you may not have to switch.
posted by AlisonM at 7:13 AM on January 4, 2011 [4 favorites]

There are two parts of your discussion and you need to make sure that you are separating them carefully. One is the actual financial and time commitments which are a nusiance to you. That's a customer service / service provider issue. That is off the table and cannot be discussed in context of "Make this better!" (He charges what he views the market will bear.)

What you can discuss is that these things are stressful and you recognize are counter-productive to your therapy. Dealing with these stresses are things that you can discuss - maybe the two of you find a different place to meet. Maybe the two of you change your frequency, maybe you learn just how to mitigate the other issues so you can handle these too new issues better. There are a multitude of different strategies which you may find avail themselves with your honesty and separation of your inner struggles and the financial/time aspects.
posted by Nanukthedog at 7:13 AM on January 4, 2011 [2 favorites]

And yes, sliding scales exist - but do not expect a sliding scale - let him offer it if he views that as a possible strategy.
posted by Nanukthedog at 7:15 AM on January 4, 2011 [1 favorite]

Also, if you do need to switch, he may be able to recommend someone who also does whatever he does that works for you, and/or someone he knows he can work with to ease the transition.
posted by winston at 7:18 AM on January 4, 2011 [1 favorite]

Actually, he may lower his prices. I discussed the same with my former therapist after I moved out from under my parents' financial umbrella, and she offered me a lower rate because we had a good relationship and because it was easier to keep me (a reliable client who she knew would continue to see her and was not shopping around for other therapists or was otherwise not a good match for her services) than to wait for another client who could pay $30 or so more to take over my appointment time.

Also, speaking as a(n admittedly new) therapist myself, anything that causes you stress is fair game for discussion in the therapists' office. I don't think he'll feel as though you're pressuring him to do something. He'd rather know about your stressors so that he can better understand how you're being affected by them; otherwise, he may attribute your behaviors or moods to other factors that may or may not have anything to do with what's really going on.
posted by pineappleheart at 7:20 AM on January 4, 2011 [5 favorites]

If it is stressing you out, it is appropriate to discuss with your therapist. I also don't think it's such a bad idea to just tell your boss "I'm going to see my therapist." Honestly, it's not something to be worried about. The couple of times I've told my supervisors, they've been very understanding. In one instance, one of them even confided that he'd been in therapy for years now.
posted by Gilbert at 7:23 AM on January 4, 2011 [1 favorite]

Can you ask him if Skyping is a possibility? He may still be disgustingly expensive, but at least you would cut out of the stress of getting to his office.
posted by Leezie at 7:25 AM on January 4, 2011

I was in a similar situation, and as much as I really loved my therapist I should have had her recommend someone who was on my insurance. Money can be a such a huge stressor.
(I ended up losing my job and having to stop going to therapy completely, which turned out OK since the job was a big part of what was making me crazy...)
posted by Green Eyed Monster at 7:28 AM on January 4, 2011

You should definitely talk to him. He's certainly had to deal with this situation before and knows what can and can't be done. I was in a similar situation where it was difficult to leave work early, and my therapist agree to two phone sessions a month during my lunch break.

On the other hand, when therapy became too expensive for me there really was no answer and I had to stop. I'm still glad I brought it up with my therapist.

Like I said, he'll know what's possible and not and can tell you the best available options. Also, consider telling your boss you have a regular appointment on whatever days you go to therapy. You can totally make something up if you want (e.g. I'm taking a class on blah at blah).
posted by xammerboy at 7:30 AM on January 4, 2011 [2 favorites]

I'm at work, so can't link to the therapist blogs I have in mind, but absolutely do bring up your financial concerns and ask if a sliding scale is possible. All of the conscientious therapist blogs I read say that they're happy to consider it, and discuss it as part of therapy (a stressor is a stressor, whether it's a cruddy childhood or financial worries). Also, in contrast to what Nanukthedog suggests, they prefer that the client bring it up since it shows, in part, that they're willing to face stressors. Indeed, there's no guarantee your particular therapist will agree, but you have nothing to lose, and much to gain (continuing and strengthening the therapeutic relationship you've built), by asking.
posted by fraula at 7:34 AM on January 4, 2011 [1 favorite]

[credentials: In and out of therapy for 30 years and married to an LCSW.]

Explain the change in your finances and say that you'll need to come less frequently.

If he's willing to lower his prices - and you have no idea whether he is or not - he'll offer to do so.

If he thinks you need more frequent therapy than you can afford at his rates, he should be better informed than you about the less expensive treatment options available in your area.

However it works out, you should feel no hesitation whatsoever at telling him everything you've told us. I'm guessing he will find your conflicting perceptions of him as both an excellent therapist and a price gouger to be significant material.
posted by Joe Beese at 7:34 AM on January 4, 2011 [2 favorites]

There are definitely thereapists out there who can do telephone visits. I could see opening the conversation by inquiring about that as a possibility. After all, it begs the question "why."
posted by Ys at 7:37 AM on January 4, 2011 [1 favorite]

Seconding the advice to make something up to tell your work. If they're not paying, it's none of their business. Raising this issue with an employer if you don't absolutely have to is probably a bad idea.
posted by facetious at 8:49 AM on January 4, 2011

IANYB (I Am Not Your Boss) but if you are concerned about how leaving early is viewed at work, you can tell coworkers/boss that you have "a doctor's appointment" and most people will leave it at that. You can offer to come in earlier or stay later another day if there is concern over missing an hour. On top of all of that, I doubt anyone at your place of employment would be as shocked as you think that you have a therapy appt - lots of people do.

The stressors with your therapist sound like logisitical obstacles your therapist would a) understand b) not take personally and c) want to help you get over. Call me another vote for bringing it up.
posted by maryr at 8:53 AM on January 4, 2011

I work full time so I have to see him during evening hours, and it is extremely stressful getting to his office during rush hour traffic.

This is absolutely something you can discuss with him - but to be clear, it is not HIM stressing you out, but your schedule and your lack of proximity to him which doesn't allow you to go during another time of the day/week.

He is not on my insurance plan and he overcharges more than anyone I've ever heard of.

He overcharges? Or he has a graduate degree and a lot of experience doing a task that requires skill and hard work (and is often stressful in its own right) and he has determined what he believes to be fair compensation for this? In my area of the country, MFTs (Marriage and Family therapists) typically charge as little as $60 out of pocket or as much as $350 for very experienced, sought-after therapists. Psychologists and Psychiatrists charge significantly more.

Still, as was previously mentioned, therapists often have a sliding scale approach. Before or after a session, I would simply mention that while your parents had been paying for your therapy in the past, you are now paying out-of-pocket for all of your therapy, and ask if he offers a sliding scale. Don't mention that it is a long ways to drive to get to his office, that really isn't relevent to the question of the fee. This isn't (or shouldn't be) bargaining, but rather honestly telling him your ability to pay.

Depending on what he says, it may be worth considering finding a therapist who is closer to you and is on your health plan, particularly if you don't foresee moving any closer or your insurance changing anytime soon. However, this is one call you'll have to make yourself, since you said that you haven't liked any other therapists as much as you liked him
posted by arnicae at 10:02 AM on January 4, 2011 [1 favorite]

Definitely talk to him about this. At the very least, if/when you decide to quit him, he'll ask you why. If the only reasons you'd quit are time and money, it's only fair to talk about it. It's surprisingly hard to find a shrink that you relate to, so odds are emotionally (if not financially) that you'd be better off trying to alleviate the problems before you quit outright.

In my case, my shrink does phone sessions with me about half the time (she insists on some still being in person), and I take an early lunch hour to do my appointments. It's entirely possible that your shrink might be amenable to this sort of thing.
posted by jenfullmoon at 12:47 PM on January 4, 2011

As for work: I also used to have to leave my work early one day a week to see a counselor. However, my first appointment with her coincided with a terrible knee injury, so I just lead everyone to believe that I was seeing a physical therapist during that time. I probably could have been honest, it was such a non-issue.
posted by Ideal Impulse at 8:12 AM on January 5, 2011