Therapist later asked for payment on strange first session
June 12, 2018 9:49 AM   Subscribe

I recently went to a new therapist, and our first session was an hour of her asking me rapid-fire questions and tapping away on a laptop. I assumed this was free, we didn't discuss any payment at the end. But at our next session, she asked me to pay for both. Should I?

She brought this up at the end of our second session without any previous warning. I don't feel like we are a good fit, but went to the second session (which would really be #1 since I had no indepth talk on our first meeting, seriously just answering very fast questions) because I felt like I'd have wasted her time if I didn't.

I was in extreme distress, like really bad, and tried to convey that to her in session #1 but she just wanted to bull rush through the questions (example: "Did you have a difficult childbirth or were there complications for your mother?" huh?). Session #2 was marginally better but she tends to talk about herself a lot in rambling weird, unrelated ways that make me uncomfortable.

So I'm going to cancel appointment #3, but should I offer to pay for session #1 at that time? I really am conflicted. I said I thought visit #1 was a consult, and she said she would check with my insurance which kinda baffled me too. It's not my intention to stiff anyone, but I feel really... bad... and kind of used by our first session. It's hard to know what's the right thing to do when you are struggling to get out of bed or eat anything. Thank you, hivemind.
posted by OnTheLastCastle to Human Relations (15 answers total)
The initial consult with my therapist was paid as well, IIRC.

HOWEVER, I'm reading a bunch of other red flags here. It's super important that you're comfortable with your therapist, and it sounds like you aren't comfortable with this person, which is a definite sign that you should find somebody else.
posted by tobascodagama at 9:55 AM on June 12, 2018 [3 favorites]

Yes, you should pay for the first session. She sounds pretty awful as a therapist and you’re probably well rid of her, but she’s still entitled to be paid for her time, just like any other professional.
posted by holborne at 9:56 AM on June 12, 2018 [28 favorites]

Are you in the United States? I would expect that every visit - including a consult - would cost money, whether that was paid by you or your insurance. I would also expect that she should have stated her rates up front, or in the paperwork you may have filled out beforehand.

I also think you should not continue with this therapist, and that your gut is telling you something you should trust.
posted by mosst at 9:56 AM on June 12, 2018 [1 favorite]

Cool, I'll offer payment, and I've learned my lesson. I shouldn't have gone to session #2, and she should have brought up our payment at the end of session #1. I do have insurance so it's just the copay.
posted by OnTheLastCastle at 10:04 AM on June 12, 2018 [2 favorites]

I'm sorry this all happened and I strongly urge you to find a new therapist asap. In the meantime, check meet ups and google in your area to find a meditation class (or similar) you can show up to today. There's a lot to be gained from sitting in community doing exercises like meditation.

Now. These fees are what I prefer to call Fuck You Money(tm). It's the money we pay to get rid of the bad people or situations in life. Pay it with the intention that the next therapist you find is the right one. You might have to try a few to get a great fit for you, but pay this person off to show yourself you deserve a great therapist that's right for you and your needs.
posted by jbenben at 10:09 AM on June 12, 2018 [1 favorite]

Likely the first session was an intake/assessment to get background information about you before starting the therapeutic process, which is typical at many agencies/clinics. However, that definitely should have been conveyed to you and sounds like it wasn't. This intake/assessment does cost money; sorry if that wasn't conveyed to you either.

If done correctly, the assessment should make you feel comfortable and should give the therapist a better idea of issues that you are dealing with in order to begin working with you. However, often the assessment is done by another therapist and not the one who will be working with you.
posted by bearette at 10:10 AM on June 12, 2018 [4 favorites]

I only have experience with the no-insurance therapists, but the ones I saw did not charge for the initial consultation. Talking about money is always awkward, but it should have been clear what you were paying and payment should have been requested at the time of service. To spring it on you is unprofessional.
posted by wnissen at 10:19 AM on June 12, 2018 [3 favorites]

Definitely pay for both. The only time sessions are free are when they have been SPECIFICALLY offered that way by the therapist, or when you are in a program that provides an initial number of free sessions. In neither case would the therapist be asking for payment. Generally the therapist explains things like this and sets general clinical expectations in the first session. It's too bad that didn't happen this time.
posted by ubiquity at 10:25 AM on June 12, 2018 [2 favorites]

She may be a bad therapist, but she's not doing this as a favor to you. This is her job, how she pays her rent and feeds her family. It sounds to me like she didn't ask for payment the first time because she was going to check with your insurance to see if it would be covered. It wasn't, so she let you know at the next opportunity that you have to pay.

By all means, you should find another therapist (and if you're in distress, make sure to let them know at the outset!), because it sounds like this one is a bad fit. But that's not grounds to skimp on payment.
posted by kevinbelt at 10:49 AM on June 12, 2018 [1 favorite]

You should have known how much it was going to cost you(either insurance copay, or self pay rate) prior to the session starting.

I've known therapists who do consultations for free, but they are rarer. Regardless, all therapists should be upfront about payment.

Either way, she doesn't seem like a good therapist for you, and there are tons of highly qualified therapists out there.

Good Luck.
posted by AlexiaSky at 11:35 AM on June 12, 2018

I would also check and see if you have something like Women's Therapy Referral service in your area. For a very modest fee you meet with and intake counselor and they set you up with mini-appointments with three different therapists and then you can decide which one is the best fit for you.

In the absence of that, I would very directly ask about how any other therapist handles intakes or initial consults and whether or not you can do a 30 minute appointment to determine fit.
posted by brookeb at 11:43 AM on June 12, 2018

FWIW, they ask about your birth because there's evidence that a traumatic pregnancy and birth can affect the future mental health of the infant, for example by inhibiting bonding between mother and child.

Nonetheless this therapist sounds like a bad fit for you. Make sure you cancel appointment three a few days early, or they might stick you for that bill too! I hope you'll find someone more sensitive to your needs soon.
posted by milk white peacock at 1:28 PM on June 12, 2018 [1 favorite]

I had a first visit like this with a therapist, in which she told me a LOT of really personal, graphic, and traumatizing information about another patient -- which she ended by saying "and she's coming in to my office here today at 5pm!" I literally lied my way though the rest of the session -- what a breach of trust, how could I tell her more about myself than I already had! -- and got outta there asap.

She billed me and I paid. I thought of it as "fuck you" money: sometimes it's worth just paying the weird person off to get them out of your life forever. This is one of those times.

Best of luck finding someone who is better.
posted by sockermom at 2:41 PM on June 12, 2018 [1 favorite]

One of the first therapists I saw didn't particularly ask me any questions and just engaged in directionless prompts for me to chatter for an hour at appointments, to which I thought "Well, I guess this is what therapy is" and then to my horror after a few months of this said, "I think you have some very mild dysthymia." This when I'd been constantly suicidal; but we didn't really get into any of that because he didn't ask any questions.

Obviously this person you saw isn't asking very good questions or otherwise assessing you well, OP, if they didn't grasp what you wanted and couldn't tell that the questions were making you uncomfortable. I'm just testifying that there are some people who would actually want a therapist to ask questions, and for my own part I feel like you should be careful what you wish for to discount the value of the question-asking. I stopped going to therapists years ago because most of them seem to take the aimless chatter approach, and even just trying to find one who will attempt to figure out what's wrong with me involved too much fruitless effort.
posted by Sockpuppet Liberation Front at 6:10 PM on June 12, 2018

Thanks, all. She offered to waive it when I said she could use my credit card if it was on file due to the miscommunication but I said I'd like to pay. She referred me to another therapist who I was looking at anyway and was overall very kind. Appreciate your advice!
posted by OnTheLastCastle at 10:56 AM on June 13, 2018 [1 favorite]

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