Should I get meta with my therapist?
October 14, 2020 9:14 PM   Subscribe

I'm feeling really miffed by the way my (mostly wonderful) therapist of 4+ years has handled a recent situation of mine, and wondering if I should bring it up in our next session. I don't want to rock the boat, but I also feel like it would be almost absurd not to bring it up, if only to let them know that this is uncool for future situations with patients.

When we last spoke, two months ago, it happened to be the day that my spouse moved out and a month after I was laid off from my job of nearly a decade. My shock and grief that day were significant, but I put on my professional face and got through that session without sobbing or wailing.

Instead of talking about the marital separation unfolding in real time (that very day!!), my therapist wanted to rewind and focus on my feelings about the job loss. Fine.

When we closed the session, instead of putting the next appointment on the calendar within a couple weeks (or sooner, usually, if I was in an acutely difficult situation), they said "well, let's wait until your insurance straightens out and then we'll schedule something." I mentioned that I had enough in savings that I could pay out of pocket if necessary. But they insisted on waiting until the new insurance came through, and that has ended up being two months. True, I have a running balance at this practice for my copays, but I have a payment plan that I follow without any missed or late payments. Also true is that I'm in the middle of several massive life changes and really really really could have used counsel during this time.

Basically, I'm feeling a little like they left me out in the cold, and that especially hurts when I reflect back on all the stuff I've shared over the past and the professional relationship I thought we had. Did they think I was crying wolf over the separation? Maybe it was an especially tight month for them financially, so that was looming large? I also have the thought that they are generally sick of me and my privileged circumstances, my petty problems, compared to other patients they see who have more severe and "real" problems.

I don't know. Should I bring this up at our next session? Or should I process it on my own? Or should I seek out a new therapist altogether?
posted by knotty knots to Human Relations (24 answers total) 1 user marked this as a favorite
I think it's definitely worth bringing this up. If it's two months later and it's still bothering you, it's significant for that reason alone -- but it's also important because if you don't have trust in their judgment or how they'll handle you, then that will make all of your work with them less effective.

A good therapist will be able to address your concerns and leave you feeling confident in them still. If they don't, then yes I think it's worth seeking somebody out. But if this was a one-off thing then it's worth talking to them first, unless there's nothing that they could say that would make you feel better.
posted by forza at 9:28 PM on October 14 [4 favorites]

Ianad but “ sick of me and my privileged circumstances, my petty problems” sounds depressed as fuck. I think bringing it up and finding someone new are not mutually exclusive. If I were depressed then maybe the person isn’t “making me feel that way” but I would have a hard time getting over being made to feel that way, it really is the worst especially from people you are literally paying to help you.
posted by J.R. Hartley at 9:29 PM on October 14 [10 favorites]

I'm sorry that your therapist left you feeling left out in the cold!

I don't know what you should do to be honest because there's something a little bit odd in the way you talk about your therapist and your relationship.

So you describe your home life and your work life both changing radically in the span of an extremely short time and how destabilizing and scary that must have been. But you also describe "putting a professional face" on for your therapist and not sobbing or wailing through your session. In my opinion, sobbing and wailing with your therapist in a moment like this is important and warranted. If you were holding back just how shattered you felt with your therapist, and also talking about your job situation, it may have been that your therapist was trying to help you through a difficult time by focusing you on the more professional aspects of your relationship, following your lead.

You are making assumptions and trying to guess at your therapist's motivations and it also sounds like you're holding a lot back from your therapist. Why is that? Why don't you feel like you can emote fully with them? Especially in a crisis?

If I were you I'd try to find a way to bring this up. Tell them you felt like you were left out in the cold, and you were wondering why they focused the conversation here. You should ask them all of these questions and see what answers you get. I also think you should be prepared to get answers you don't expect!
posted by pazazygeek at 9:30 PM on October 14 [43 favorites]

I'm very sorry you are going through this, knotty knots.

Your situation is of course unique to you, but it is widely accepted that the relationship between client and therapist is anything but simple. You should bring it up because it is something you are feeling distressed about.

You might also find it helpful to read a book like On Being a Therapist (I'm reading it now). It talks a lot about client insecurities, the kind of attachments that can occur (clients idealizing their therapist, therapists getting triggered by overlap between a client's issues and their own, etc.). I have found the book helpful in humanizing therapists.
posted by Corduroy at 9:34 PM on October 14 [2 favorites]

Absolutely bring it up. Therapy is the one place you talk about these awkward, hard to discuss things with someone who is presumably skilled in having uncomfortable conversations. Humans make mistakes and hurt each other all the time. The magic is when you are able to let the other person know that they hurt you and they care (!) and they respond with both honesty and empathy (!) instead of getting defensive. Of course, it might not happen that way, but a good therapist will genuinely want to know when they missed the mark and then you get to find out which of your guesses about the therapist is thinking were right (or none of the above) and the two of you can clear the air and repair the relationship.
posted by metahawk at 10:00 PM on October 14 [1 favorite]

My shock and grief that day were significant, but I put on my professional face and got through that session without sobbing or wailing.

I know, from personal experience, how destabilising the shock and grief of a marriage ending is on the day/s it happens. For me it was like the world had turned sideways and I was slipping off. Which is why I don't understand why you put on your professional face in the therapy session. Where was your grieving face? Perhaps you covered up your distress too well and your therapist could not discern how upset you were.
posted by Thella at 11:14 PM on October 14 [19 favorites]

This kind of situation, unpleasant as it can be to go through, is often a useful litmus test for whether a therapist is (/is still) a good fit for you. If you can have that conversation and come out feeling held/understood and with your frustration resolved, they're probably still a good fit. If it doesn't go well or you don't get the acknowledgement/understanding/resolution you were seeking, that's probably a symptom that they're no longer a good fit. The best therapist I've seen was someone I could have had this conversation with, and in retrospect it was a sign of a bad fit with others when I felt very uncomfortable brining up these kinds of meta-observations about how well the process was working for me.

No judgement for masking your feelings initially, by the way. Sure, it might be healthier if we all didn't do that, but as someone who's done that a lot in the past (maybe for different reasons, in my case a toxic childhood where I wasn't allowed to not be okay/to be obviously melting down in front of other people), if that's where you're at, that's where you're at. The more important thing now is whether you're able to honour and acknowledge how you felt then with your therapist even if it wasn't apparent to them based on how you presented during the session in question, not fixing up a time machine to go back and get more real about your feelings that day in the first place.
posted by terretu at 12:52 AM on October 15 [11 favorites]

I would bring it up. I see a pattern here and it’s hard to interpret from the way you’ve written about the experience. You said your therapist “wanted to rewind” and talk about the job loss. Did you specifically say you wanted to talk about your other grief? It’s unclear.

Same issue with booking the next appointment. You say that you mentioned you could pay out of pocket, but that is not actually the same as saying “no, I really would like to book a session.” It’s similar with the two-month gap; did you call up and ask for an additional appointment?

You may think you are communicating your desires and needs but from what you’ve written, I can’t tell. It sounds a bit indirect. If you weren’t direct, then I would definitely take both these things up directly and see what the response is before looking for a change.
posted by warriorqueen at 2:39 AM on October 15 [18 favorites]

I posted a similar question recently about feeling not heard by my therapist. With an update about how I brought it up and was very happy with her reaction. I think maybe reading it might help?

I think we maybe sometimes overestimate how well a therapist can see the "real" us behind our together face, precisely because they often seem so good at it. But they can be just as humanly obtuse as the rest of us.

So I second the idea that what you wanted (talk about the dissolution of your marriage) was maybe not as obvious as you thought it was and that you don't seem to have directly asked for what you want. Like, if I have two crises going on (job and private) and my therapist asks how I feel about today's development on the private front and I bravely and resignedly shrug and say "eh, it is what it is" (something I can see myself doing), she might decide to return to the job thing that seems to bother me more. Maybe.

Or maybe you really don't want an obtuse, disinterested therapist who should have known to dig deeper. I mean, two months is a long time even for clients who don't have major shit happening to them.

Either way, I think the only way to tell which it is would be to speak up and see how she reacts. I told my therapist that it is very important to me to feel like she understands what I mean. She immediately picked up the signal by asking if I felt she was doing that, which gave me the opening to say, well, actually... I liked how we got to unravel everything from there and I feel it made a huge difference in my trust level to be taken seriously that way.

Bring it up directly and see if it changes things. If you continue to feel dismissed, this is not a good therapist for you.
posted by Omnomnom at 4:06 AM on October 15 [4 favorites]

you describe your home life and your work life both changing radically in the span of an extremely short time and how destabilizing and scary that must have been. But you also describe "putting a professional face" on for your therapist

THIS. And the rest of your story clearly describes why you did this: you don't trust your therapist to be sensitive to your feelings. Your therapist has failed in the most fundamental aspect of their job, which is to create a safe space for you to talk about your true emotions. Whatever is happening in that room is decidedly not therapy. I cannot emphasize this enough.

Imagine if you had talked about going to the dentist in this way?

"My dentist knew I had a really bad toothache in that molar where I have a cavity, and on the day before the appointment, my braces accidentally moved out of alignment. But I was able to put on my 'professional teeth' for my dentist and get through that appointment. My dentist never enquired about my molar with the cavity, even though they knew it is a serious issue that's causing me a lot of pain - the dentist only wanted to talk about my braces. Then they didn't give me another appointment for two months, so I have to live with this excruciating pain in my cavity for so long!"

I'm trying to tell you that your dentist is not providing dentistry services to you. They are failing at the most basic aspect of their job. There is something very, very wrong with a dentist who makes you feel like you cannot bring up your cavity pain and who doesn't bother to ask after it even though they know about it!

(I will note that in my opinion, this is a radically different circumstance compared to Omnomnom's case. That therapist did not make Omnomnom feel so extremely unsafe in the therapy that Omnomnom needed to "put on a professional face" to refrain from mentioning their most central struggles to the therapist. Their therapist did not knowingly fail to talk about these struggles and did not brush off their request for an earlier appointment in the middle of a huge double-crisis. What happened to Omnomnom, IMO, is leagues different from what's going on here.)
posted by MiraK at 4:14 AM on October 15 [4 favorites]

I don't quite want to say that your therapist is a bad therapist - but, I think that you don't have the kind of therapeutic relationship that you want & need.

That could be on them, and it could be on you. You have to speak up for the things that you want. Even before you can do that, you have to recognise the things that you want as Real and Important, and recognise yourself as a person who's fully deserving of having your needs met, as we all are.

It's also on your therapist to help you to do all of those things. If we didn't need help with them, I guess we wouldn't bother with therapists at all. But, I think you have to give them a little bit of help, so that they can help you. If you squash your own needs down into such a tiny box, maybe even your therapist is going to miss them.
posted by rd45 at 4:23 AM on October 15 [5 favorites]

Bring it up! The therapeutic relationship is the perfect place to actively engage with conflict in a healthy and supportive way.
posted by spindrifter at 4:30 AM on October 15 [1 favorite]

Could this have had to do with money? Either concern that draining your savings on therapy would be bad for you, or concerns that you couldn’t/wouldn’t pay your bills? “I had enough in savings that I could pay out of pocket if necessary” seems at odds with “I have a running balance at this practice for my copays.”
posted by slkinsey at 5:22 AM on October 15 [7 favorites]

Therapy stops working when no one is willing to "rock the boat." Your therapist attempted to rock by changing the subject to job loss. And you need to rock back, or at least discuss your reluctance to do so.
posted by Obscure Reference at 6:24 AM on October 15

I guess I overestimated how much my therapist would have been able to tell I was upset, not because I was crying--I seem unable to cry in front of her and most other people, always have been--but because of contextual clues (and, reading this, I realize I can't expect anyone to read my mind!)

The financial stuff...if it's a monthly payment I can make that doesn't accrue interest, I generally don't see a reason to pay it off as a lump? I'd rather keep my savings account healthy and treat the medical bill as any other monthly bill I pay. But that's neither here nor there--just wanted to clarify my mindset on that.

I will bring it up, I think, but I may wait and see if they offer any comment. I don't want to go in guns blazing, especially when there are more pressing topics in my personal life to discuss.

The perspective on this has been really helpful--thank you for these responses.
posted by knotty knots at 7:29 AM on October 15

I generally don't see a reason to pay it off as a lump? I'd rather keep my savings account healthy and treat the medical bill as any other monthly bill I pay

it may be, as others have suggested, that in postponing your appointment they thought they were being protective, or nobly refusing to take financial advantage of your distress. but if I as an independent contractor had offered a special payment plan to someone, thinking they were in some need & I was helping, and found out they took this attitude to it, I would be furious. (that is if your therapist gets paid by you directly, not by a larger practice.) and if I were a furious therapist, I would sublimate my fury at a client into detachment or passive aggression, as is the professional way.

of course, your therapist offered you this of their own free will, and if they needed to know your exact finances before doing so, they should have asked. but resentment is often irrational, and therapist/bill collector is one of those "dual relationships" that notoriously fucks up the integrity of a therapist/client relationship. obviously the therapist needs to put your interests first as a therapist and their own interests first as a creditor, and this is an essential conflict.

if it's not about money at all, as it may not be, your therapist is just not a very attentive person. whether you were crying or not (obviously you do not have to cry to express emotion!) a reasonable person would have said: Will you be all right for the next two months? It's longer than we usually go without an appointment giving you the opportunity to say No, I really need to talk about my marriage ending, do you have any open appointments sooner.

you should say something asap, not because "they can't read your mind" -- no, they can't, but they can observe human behavior and reason from it -- but because they sound like the kind of therapist who will be happy to blame you for not speaking up, if you don't, and make that the subject of therapy now and forever, taking off the table the subject of their choices and what you can reasonably expect from them. which is important for you to know.

Seeing someone for four years without ever having a steady appointment is unusual and if you have to endure the suspense of scheduling a new session each and every time, that could prevent you from ever relaxing. worrying if your therapist is going to get tired of you should wear off after a while if they provide reliable, steady availability, as the weekly/biweekly standard is supposed to do. maybe your personal situation requires this, but it's very not ideal. get mad, see what happens. if they react badly, you absolutely do need a new therapist.
posted by queenofbithynia at 8:20 AM on October 15 [5 favorites]

I will share this because it's somewhat similar to your experience, especially as I look back on it. The one time I did individual therapy for perhaps ten visits there was indeed a copay but nothing I couldn't handle. I know I was administered a psych test. And I probably was more stoic (or light joking) than overtly emotional, that's how I lean. But after a while there didn't seem to be a direction to our visits. I didn't see any particular focus on my particular concerns, just a lot of question/answer exchanges with him keeping notes. Eventually I told him that because I just didn't see it going anywhere I was choosing to stop, because it was a significant investment without any apparent return. He immediately started talking about reducing his fee for my financial situation. I said you know what I do for a living, it's not that I don't have money, it's I don't have money to burn.

So my point with regard to OP is that I should have been explicit in the first one or two visits of exactly what I expected, and asked him to lay out what I could expect in the way of the process and length of therapy (roughly). Then I could have avoided any confusion or disappointment.

Of course, this was many years ago, and since then I realize that sometimes multiple therapists need to be "tried out" to find the right one, and also perhaps he should have voluntarily described the process and intended near and long term results.

So for what it's worth, I agree with those who say you should bring it up at some point to "clear the air" or make sure you're both on the same page. I wish I had done that on my second or third visit.
posted by forthright at 8:33 AM on October 15

> So my point with regard to OP is that I should have been explicit in the first one or two visits ... Then I could have avoided any confusion or disappointment.

It's a therapist's job to begin this conversation and guide patients through it. People who seek therapy often have no idea what the "rules" and the "best practices" are, how can they, this is not their area of expertise. It is the therapist's.

Whether it's a patient who finds it hard to articulate their reasons for seeking therapy, or someone who finds it difficult to discuss anything in emotional terms, or a patient who hasn't developed a deep sense of safety in the therapeutic relationship after 4 years (!) ... it's a core responsibility of the therapist to take the lead in addressing it. Many of us go to therapy *because* we don't have any idea how to bring up these issues on our own.
posted by MiraK at 8:45 AM on October 15 [3 favorites]

I will bring it up, I think, but I may wait and see if they offer any comment. I don't want to go in guns blazing, especially when there are more pressing topics in my personal life to discuss.

I support you! But I wanted to say that I don't think that bringing any of this up would be "guns blazing." I think it actually could be really valuable - if your therapist responds well, you may be able to work through things like crying in front of people or helping people interpret context or even just expressing your needs.

If your therapist responds badly, new therapist.

Just to add - I had a great therapist I saw weekly for 5 years.* There were at least 2 times that she either messed up or we had a big miss between us. Both times the way she responded was at least as valuable to me as half the more regular appointments were.

I also had a bad therapist where I brought up something even more fundamental and his response was - b.a.d. I dumped him, best decision I made there.

Therapists should be good at things, but they won't be perfect, and the only way to find out the difference between a mistake and stupidity is to bring it up.

*I find the idea of scheduling each time disturbing and that would bother me, but what do I know.
posted by warriorqueen at 11:23 AM on October 15 [3 favorites]

I would like to rewind (so speak) to the deferring of discussing your partner moving out. Maybe I am just bad at therapy, but I am horrified that your therapist would think that a job loss from a month ago was more pressing than a separation happening that very day. I'm trying to think of a scenario where the end of one's job could possibly be more important. I would bring it up and hope for a real apology.
posted by wnissen at 3:55 PM on October 15 [2 favorites]

I am a (student, but have been seeing clients for a year) therapist, I am not your therapist, etc. There are times in therapy where clients come in to session and tell me that had a personal loss that week. I always spend some time processing it, but unless the client specifically says or tries to direct us to talking about it more, I am not going to spend much time on it beyond basic processing and empathizing, at least not immediately. Why? Because I do not want to interfere with the natural process of grief. It's inappropriate to shift the focus of therapy to grief counseling before you know whether a person needs that, which you can't tell until you've given it some time (note: this is different when the event was clearly traumatic, at which point you want to intervene as soon as possible). Grief is natural and normal, and it can actually be harmful for a therapist to come in too soon, before you've had time to sit with your own thoughts. It's possible your therapist wanted to give you space to process your feelings surrounding this situation and not jump in immediately to influence that. That said, if a client clearly wanted to keep talking about grief or loss, I would expect the therapist to follow that.

I would also definitely want to keep meeting weekly with someone going through grief to check in and make sure they are't becoming overwhelmed by it. So that part does seem remiss to me. But I don't know how the financials play into it. It may be in the therapist's eye you are way, way behind on payments ("running balance" isn't a thing--you are behind on your payments, regardless of whether you're on a payment plan to get caught up) even when the cost is just a co-pay, and it seems unwise both for you and her to add the much larger expense of fully out of pocket sessions. I understand that you really could have used therapy during this time. But this is your therapist's job and she is not getting paid in full for it. She isn't obligated to provide therapy for you that she isn't properly paid for. It would have been better to have a conversation about that rather than letting it stretch to two months. But it sounds like your therapist has been, in effect, taking a pay cut to see you, and she may have been unwilling to potentially take an even larger paycut if insurance wasn't going to be in play.

As for what to do, I would 100% bring it up. Getting meta is a very important part of therapy! Talk about this, and your fears about her "getting sick" of you, your feeling that you needed to put on a "professional face." Like others have said, see how that goes. If she's willing to process that with you and work to improve your relationship, good. If she blames you or dismisses your concerns, find someone new. It's clear that you don't feel like therapy is somewhere you can share everything--after 4+ years, I wouldn't expect that. But as much as therapists try, they're not mind-readers, so your therapist may not realize how much you're holding back from her. On the other hand, it could be that she's just not providing a safe space for you. But I don't think you can know that without taking a little risk and bringing it up. Any good therapist should expect and be prepared for something like this.
posted by brook horse at 4:10 PM on October 15 [3 favorites]

Some of the answers here surprise me. You shouldn't have to formally announce to a therapist that marital separation and job loss are distressing. That should be super, mega, ultra obvious. (And if you don't "seem upset," a person whose job is the professional search for psychological insight should still know that these are significant matters, and be prepared to help you through it.)

As for the financial stuff, if your therapist is upset about money, they need to address it directly. The "professional" thing is not repressed/detached fury, OMG; the professional/adult thing is to say "Your running balance is not something I have the capacity to keep up forever, and I'm concerned about how your changing insurance will further impact that balance. Do you have the ability to pay off your balance now?"

So, either your therapist is lacking insight/attention, OR they let an inability to discuss money interfere with your care, OR they had some kind of a lapse due to their own position in the pandemic stress mess that we're all living through. If you really think the therapist is mostly wonderful, I'd try bringing it up, but I also think you'd be justified in finding a new therapist.
posted by hungrytiger at 7:03 PM on October 15 [4 favorites]

I will bring it up, I think, but I may wait and see if they offer any comment

Eh, isn't that just another way of putting on your "I'm coping" face for your therapist and hoping she'll recognize the problem despite that?

Your problem with your therapist is a real and serious one, regardless of what exactly went wrong (And MiraK may well be right that this person is a terrible therapist). They let you down in a big way. You're not coping with that well, and that makes complete sense. What if you let her see that you're not coping?

What might happen if you did go in there with guns blazing?
posted by Omnomnom at 11:38 PM on October 15 [3 favorites]

Just to clarify, I'm not saying you must address it with your therapist. Finding a new therapist is definitely an option.

I just think that "wait and see" in this case might be part of the same pattern of distrust.
posted by Omnomnom at 11:46 PM on October 15

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