Comments for Feeling Abandoned by a Therapist She Can No Longer Afford.... at http://belleruthnaparstek.com , comment 1 to 23 out of 20 comments http://belleruthnaparstek.com Sat, 13 Mar 2010 07:24:58 +0100 FeedCreator 1.7.2 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-1091 Oh, sweetie: That just happened to me...after 6 years; I cannot pay....at least full amount for 3 months. I would have bet my life he would have lessened the $$ for that short of a period of a time. I realize he needs to be paid, obviously......Please feel free to e-mail me anytime: wacalice@aol.com I wrote to my t and said: "ABIDE....do not abandon." I spent a week shaking, sick to my stomach, and with the dry heaves and finally asked to come in even tho i couldn't afford it. The stress was just too much (childhood of abuse, 31 years of abusive marriage, church that voted me out of membersship.....etc. He said: "Every man in your life has failed you." That began with a father I never knew......he has now added his name to the list. I hope you will see and read this and contact me. I do understand. Love, Allison - Allison Thu, 14 Jan 2010 13:04:45 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-841 Thank you Mariam. I am aware that specific information is missing. I do not wish to discuss the financial issues and any arrangements which were or were not made between myself and my therapist. As I stated earlier, I am aware of the professional fee for services rendered. This is not the root of my problem. I understand a person has to be paid for their services. This was my first time in therapy after many years of ignorance as to how to move forward in my life. One of my major issues is TRUST, ABANDONMENT, REJECTION, ANXIETY, DEPRESSION, AND PTSD. I believe all of these matters have been "triggered"...see, I did learn some of the terms. I need to speak about these feelings and am unable to speak with a professional about them because I keep getting responses which are basically non responses. I understand one professional does not want to speak negatively about another professional from the same field. I am not asking anyone to say they approve or disapprove of my situation and my therapist's method of handling my situation. In fact, I still have great respect and admiration for (him/her). I am sure that most of what I am feeling is exactly what Belleruth mentioned. I do feel young. The feelings are painful. My life mirrors my past and my childhood. These new feelings are very familiar and I get confused about how to handle them. I don't know how to do so. I have downloaded numerous podcasts related to this issue and plan on listening to them. I am hopeful that I will make it through this period stronger and that I will learn to handle it in a positive manner with or without any help from any of you who seem to feel offended by my feelings and any of my reactions to my situation. I tried to BELIEVE words which I did not offer. Words which were spoken freely from the professional.. Words about caring and so on. I wanted so badly to trust those words and understand those words. I dont have my own reference points for words describing an emotion or mushy things. So, I looked to the therapist as instructed to show me what they meant. I got confused because I dont understand the words in any way except in an intellectual way. I hope this clears up my question to Belleruth. It was not because I wanted or felt justified to receive free help from a professional who needs to feed her children, and pay her bills-as Stephanie mentioned. I asked Belleruth because she was recommended by my therapist. (Hence, I must have trusted the therapist to go to the conference and to ask Belleruth a question when my therapist became unavailable and found myself without any professional guideance). I think Belleruth did help by identifying what I am feeling. I am doing what I can to learn how to deal with grief. That is the problem not the payment for services which has been so difficult for me at this time. I have had many many losses, many premature, many very close to me at young ages. Hence, I feel young. I will find my way. I feel empowered by Miraim's post and thank her and others who wrote supportive comments. I will not post or respond to these comments anymore because I dont like posting personal things about myself anywhere, especially the internet. This is my life, not my profession. A very different perspective when its a person's personal life than a person's profession, I assure you. Thanks again, Belleruth for your response. The days pass. Some days are better than others. - Sarah Sat, 12 Sep 2009 18:48:36 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-839 I just wanted to expand on what Linda had to say about our healthcare system and that it's a violation of human rights for people to be denired care due to finances. I had one client who recently lost her health insurance, and she was unable to pay my lowest fee from my sliding scale. Another one found out at the beginning of the year that her deductible was $1000, and that was financially beyond her means, so she chose to discontinue therapy. It looks like now we've lost the public option, when a single payer plan, not tied to employment, is really what we need. - Joan Saks Berman Fri, 11 Sep 2009 01:20:41 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-838 Sarah, if you can bear to read another comment, I completely hear your dilemma and distress. You have my sympathy. I've been there, I am not a therapist. I was terribly disappointed in Belleruth's response which I can imagine may have been devastating for you. This was surprising because I've found the PTSD CD to be very helpful, very well done, and to demonstrate real understanding of what is needed. Trauma is so delicate and requires complete trust and gentleness. Consistency from the therapist is essential. Feeling abandoned or rejected would magnify the vulnerability and anxiety, very likely trigger flashbacks, and compound the trauma. Your professional "guide" has let you down and trust has possibly been shattered. 'This too does not easily pass' under such circumstances. I hope that the responses have not damaged the healing you may have found in the PTSD CD and that you can still find hope and help there when money can be hard to find for other help these days. There are so many good things in the CD to hold on to and give you courage and strength to find what you need. You may have to be creative going forward if you can muster it, and, yes, assertive. It was your therapy, it is your life. Keep going, hang in there, there is help and hope for you. There are many professionals who will understand your situatiion and help you grasp what has happened and how to go forward. It is possible to seek an impasse consultant for support, understanding and guidance. Use whatever resources you can find. The pain you are experiencing might feel enormous. Try not to become bitter or to fight the pain but perhaps try to allow it and to internally expand to accomodate it as you make your way. Breathe, meditate, exercise. Have courage, be strong, find any of your own internal resources and strengths you can and try to trust yourself. Really look at who/what your own "guide" is, it is still there for you, you are not alone. Try to take very good care of yourself at this time. I hope that eventually you can become a greater person for your efforts. Professionlism in any field is about so much more than money, information, protocol, etc. etc. It is about respect, dignity, empathy, and ever striving to rise above oneself and one's human frailties. I send you love and wish you luck. - Marian Thu, 10 Sep 2009 14:03:57 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-837 I am of the opinion that therapy progresses at times in massive quantum leaps forward, and that such times are often linked to moments when the unequal power relationship between therapist and client is equalized by active steps by the therapist (while maintaining professional integrity and boundaries, of course). Where a genuine financial hardship exists, and where a responsible client intent on progress and self help faces such hardship, a reduction of fee, or probonno treatments are a powerful way of equalising the relatinship. In my opinion, as such, it should be employed for a period of time. It is interesting that no responses suggested case by case assessment and decision making here, yet much of therapeutic action is based on individual case by case assessments. Why not also this financial issue, given it is so central? I would be interested in a comment from Belleruth, and a subsequent debate, on the issue of equalizing power between therapist and client and its therapeutic value, - Kristina Thu, 10 Sep 2009 11:12:11 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-836 Our health care situation is a real crisis and a terribly sad statement of our values as a culture. I agree that therapists need to earn a living and, as someone pointed out earlier, there's a reason that there is walMart as well as Bloomingdale's. I don't think people generally understand that a relationship with a therapist is not a friendship. You would probably help a friend with some home improvement or whatever and you could expect that they would reciprocate when you need that. But a client is not the therapist's friend even though there is caring involved. Like other professionals, they count on an income. I can't go to my hairstylist or electric company to ask for a sliding scale. I think people assume that social workers and therapists "should" provide services just because they care, but it is a luxury that very few are able to offer. - josie Thu, 10 Sep 2009 11:12:06 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-835 Clearly this is an issue that pings on a lot of people, whether therapists or clients. One thing to note: it's not clear whether this therapist was already operating with a sliding scale (most do, in fact), and perhaps even those lower rates had become untenable, due to the client's income loss. We just don't have that information. - belleruth Thu, 10 Sep 2009 09:53:01 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-834 There is obviously a lot to this predicament. Empathizing with Sarah is vital for her to get better. That a therapist is a professional can range from significant to superfluous, depending again on how helpful the therapist is. Making a lot of money is not something the client is blind to; quite the contrary; speaking for myself being in therapy involves thinking about how important the money is to the therapist and how important I am. What I found missing in the comments made in this article is matter of degree (and possibly flexibility). In other words, a slight bend here or there showing that the client is important to the therapist--important-enough to give up some of that all-important cash can be in and of itself therapeutic in my view. That's why sliding-scales are so valuable and in my opinion therapy without a sliding scale too narrow. Sarah wanted caring from a therapist who did not recognize Sarah's need for financial flexibility enough to let go of her own need to get richer.... - Larry C. Kattan Thu, 10 Sep 2009 00:54:32 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-833 I am a mental health provider myself. I think this is one of the most unfortunate aspects of our nation's health care crisis, when vulnerable people cannot obtain needed services. I am uninsured and travel 2-1/2 hours for medical care because that physician will accept me as a uninsured patient. When I left a job with "benefits" the COBRA coverage was $1600.00 per month because of a "pre-existing condition", so I have been on the other end of the fee scale as a patient as well. Maybe it will help to know this is usually not just an issue of compassion, time,or professionalism. It is a LEGAL issue driven by insurance companies who want to insure that they don't pay more than another insurer. What that means is that as a clinician I have to set my fee and not discount that fee in any way, including waiver of co-pays or deductibles from client to client. I would gladly offer a sliding fee scale if I were allowed to and could do so in an equitable, ethical way. Generally, the paperwork required to do sliding fee scale legally without risking insurance fraud charges is too overwhelming for a solo provider to manage. What is frustrating to me is that from insurance company to insurance company reimbursement rates vary WIDELY ($40-$120 per session!!!) so in reality clients (and insurers) DO pay different fees, but as clinician I don't have the latitude to change fees without being at risk for insurance fraud charges. I don't have the latitude to say one client can pay this amount and another client can pay X amount based on their financial need. Additionally, I am required to make at least two "reasonable" attempts to collect fees if I am to avoid insurance fraud charges. I don't know if this will help or not. It is also an ethical issue to set fees and maintain them consistently. I live in a small town. Imagine how I felt as an uninsured when I paid the full fee of nearly $1500.00 for medical care and later learned that the provider (who does not accept insurance!!) had given the same "service" to someone else without charge. I hope this will give some additional perspective. - Louise Wed, 09 Sep 2009 23:05:12 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-832 GO BELLERUTH! - Mat Tonti Wed, 09 Sep 2009 21:54:35 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-831 Oh dear this is a difficult and complex situation now isn't it? As therapists we 'are there' for our clients, and as clients we want our therapist to 'be there' for us. Sometimes we each loose the fact that this is a business and the therapist is worthy of his/her hire. As a client we agree to pay a fee, even if it is negotiated, and when that is no longer possible we go to someone else whose fee is affordable. Not everyone can go to Bloomingdate's; that's why there is WalMart. Therapy is about becoming responsible for our own life, warts and all. It is a life long process. Yes, therapists make mistakes; and yes, clients make mistakes. Belleruth I so appreciate your balance and positiveness in your response. Every time we get some 'yuck' from life we have a choice as to whether we will grow from it our sit in our messy diapers. Not aways an easy situation; but I trust that the Universe will send me just what I need to go forward even if it is just the tinyest bit. So here's good luck to all the therapists and to all the clients out there and may your path be filled with good learnings! - Ruth Wed, 09 Sep 2009 20:04:14 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-830 Thanks, Belleruth for your compassionate and practical response.And to Sarah,sometimes blessings really do come disguised as setbacks.I've seen it many times in my life--bet you have too.Of course this may mean very little to you right now--the pain is too fresh.But can you at least try to allow for the possibility than this may lead to some good that,for now is just outside of your imagination? You may later see just that.Either way, I can promise this is a habit that will serve you well in your journey toward healing.It has helped me greatly! Peace - K Turner Wed, 09 Sep 2009 18:21:45 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-829 In response to the comments regarding my question regarding feelings of abandonment, I would like to say thank you to Belleruth and the other individuals who posted supportive comments. With regards to the professionals and in particular, Christine, I do not disrespect your profession or your training and the expense you endured to become trained and educated in this field.I too am a professional and rely on payment for my services. My question was about the actual relationship itself. I am new to your profession and have divulged incredibly private information to a therapist. I am right in the middle of a number of crisis and have lost my footing due to my financial situation. I believe your comment was directed more towards your own personal situation and not at all helpful to me. I will not go into my entire story, however, I guess I am getter better because I feel like I should assert myself and let you know that your comment is offensive. Of course I realize the relationship is professional. I will not say more because I dont believe any comment from you will help, instead, it is likely to more hurtful and I am very fragile at this time. Once again, thank you to those of you who commented and supported Belleruth's response. I do plan on concentrating on the greif and loss aspect of this situation and I believe it will help until I feel stronger and less wounded. Sarah - Sarah Wed, 09 Sep 2009 17:25:26 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-828 Sarah, My therapist of many years told me: you pay me for my time, not for the love and caring. It really helped me understand that her time is valuable and that she could not afford to help me, if she couldn't eat or pay the rent. Hang in there. Keep going to your temporary counselors just so you are heard -- and trust that the Universe will help you along if you really want to help yourself. You must help YOU right now and it's a good time to test what you've learned already (where is your anger? tell her how angry you are in your mirror -- I used to yell in my car as loud as I could on an empty street, too). Keep reaching out, many people have been down your road -- me included -- and I am living a good life now. Hugs. - Bobbi Cunningham Wed, 09 Sep 2009 13:38:30 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-827 As a therapist, this is an issue I think many of us struggle with. The bottom line is that although we are caring, compassionate people who give of ourselves, we still enter into this relationship as professionals... this is my career and how I pay the bills, feed my children, etc. I would love to offer free counseling to those that need it and who value me as a professional, but I am just that... a professional and not a friend. Compassion, love, trust, caring are all part of my tools. I keep a certain percentage of my client base pro bono, however those are for limited time so that I can share that time with the many others who need it. Its a catch-22 for therapists... we invest large amounts of money to get trained in a profession that involves us in taking care of people with painful needs that touch our hearts... and clients need to also value that level of training that they are paying for. - Christine Wed, 09 Sep 2009 13:38:01 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-826 From a client perspective; if someone chooses to be a therapist, they have to decide before the issues comes up, of (1) whether they will deal with sliding scale or not -- and to be clear about their fee policies from the start with the client. (2) if they will do long term or short term therapy as the fees should be based on that also (see below)(3) if they have their own assessment tools if the client is getting their money's worth. Maybe ask your client! Open the dialogue yourself! Value vs. price is an equation in all transactions involving money, even therapy. Maybe if the therapist wants to do long term therapy, they should think about keeping overhead costs low and not getting a big fancy office in a great part of town. I had issues with money for much of my therapy and found lots of ways to deal with it. First therapist was at a sliding scale level but left due to pregnancy. I was extremely angry (abandoned)and went to one she referred me to that after 3 sessions stated she would not do sliding scale beyond a $20 reduction. I became angry again. I went to a student counselor for awhile (who decided I was a multiple personality!) which led me to another therapist who had a REALISTIC sliding scale. I saw her for 12 years and I am so very grateful to her. I think she was able to because she really kept her overhead low (in one of the most expensive cities in the US!)and I believe, valued long term therapy such that her clients would continue to gain benefit if they could afford to go for the long haul. Plus I think she got a great deal out of helping her clients. I went to a couples counselors with my husband a few years after terminating and I was not impressed with their ability. My husband had money and the therapists we saw were such poor quality in comparison even though they charged full scale and were in great parts of town. Their lack of confrontational abilities in dealing with his abuse of me was astounding and a total waste of money. - Bobbi Wed, 09 Sep 2009 13:19:12 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-825 Sarah, I empathize with your situation. I, too, suffered from depression/anxiety and PTSD and had a therapist I loved and trusted. (I used to refer to her as my "good mother," as opposed to my imperfect mother.) She helped me uncover my memory of the abuse that began it all and helped me begin to heal from it, but she eventually failed me, and, I felt, betrayed me. I became more depressed than I had ever been before. My doctor put me on an anti-depressant, which I had resisted until then, but which I knew I needed then. I looked for another therapist, but couldn't make a connection until I went to an Incest Survivor's group at my local Rape Crisis Center and went to a therapist recommended by them. It was a very painful period for me, dealing with the PTSD and with the feeling that my therapist had betrayed me. I used many different types of healing and eventually recovered. Many years have passed now, and now that I am 'healed,' I have the distance to see that my therapist was imperfect, too. And, that as much as she may have cared for me, I understand that it was a professional relationship and not a personal one. I send you wishes for continued healing. - Michele Wed, 09 Sep 2009 12:57:27 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-824 Belleruth, thank you for your thoughful and caring response to "Sarah." I've been on both ends of this issue..the client who once wondered why my therapist increased my fee after several years, despite her knowing of my financial situation post-divorce, and as a therapist/healer, who deals with clients feelings about my own fee policies. It can be a highly charged issue, and needs to be processed therapeutically. It's a wonderful opportunity for growth to help clients understand the exhange of service for payment. For me it was growth to depersonalize it and understand that it was a business agreement between two people. I have temporarily reduced fees for clients who have lost jobs, and except for one person, they've all come to me when they have an increase in earnings and state that they want to pay their full fee again. I feel the mutual respect and gratitude too. Good luck to Sarah in her healing journey, and thank you Belleruth, as always. - Lynne Wed, 09 Sep 2009 12:52:11 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-823 Thanks to you too, Belleruth. As a therpaist I have struggled with this one too. Out of my personal growth I realize that this struggle has been a reflection of the lack of value I place on myself, my wisdom, my skills, and the value of my loving giving spirit. I am changing that and I feel that Sarah and you have provided a valuable affirmation and support for me of this change. Thanks - Deborah Chelette-Wilson, LPC Wed, 09 Sep 2009 12:44:29 +0100 http://belleruthnaparstek.com/ask-belleruth/feeling-abandoned-by-a-therapist-she-can-no-longer-afford.html#comment-821 I agree that your comments were well thought out and logical especially from the providers point of view, but I think maybe we are not asking the right question. In 1948 the Declaration of Human Rights was adopted by many of the worlds countries. The United States was the only industrialized country that refused to accept health care as a basic human right in a developed country. I think this is a terrible stain on our countries character. This year over 1,000,000 people will face medical bankruptcy. Thousands go without any insurance and they really do die because of this. Many more have insurance that covers way too little. We know that therapy often works because of the relationship that takes many sessions to establish. When insurance companies allow or deny coverage, we also know that this is mainly in response to the free market profit motif. The question we should be asking is not if the therapist betrayed her/his client by refusing to see her if she can no longer pay, but why has our country betrayed the well being of its people by allowing health care to be treated as anyother comodity that is up for manipulation to make the greatest profit????? - Linda Querry Wed, 09 Sep 2009 12:19:52 +0100