weird situation with my therapist, very confused

[carnation]

i've had the same therapist helping me with my depressive disorder, anxiety, grief, c-ptsd, nightmares etc etc for just over two years - and she has been the BEST. never had a therapist i liked so much // who actually helped so much // who i opened up to so much. opening up is real hard for me because trauma.

i also get migraines with a capital M and i have chronic knee issues and my cramps were made for a dinosaur. so, sometimes, i miss appointments. (i made up a list, i've missed 11% of our appts since january)


so, five weeks ago she sent an abrupt email changing our schedule taking our weekly sessions from twice to once because i was missing appointments, she said - just out of the blue; i reacted badly [read: massive abandonment trigger response]

we saw each other for the first time after those 5 weeks today... and holy smokes. i think i feel worse. she said nothing that made me feel better. things she did say:

-she has bent over backwards for me (...great i feel guilty?!)

-she doesn't think i respect other people's time, that if it's happening in there (therapy), it's probably happening in other places too and we should get to the bottom of that. (no one has ever given me this feedback. i generally show up to stuff.)

-i asked her if she had given me a 'warning' before that i'm just not remembering and she put up her hands and said 'we've been over this and over this' (poss., i have memory issues)

-she doesn't think i get as many migraines as i SAY i do (?!?)

-she thinks there's a possibility that i use my mental illness/disabilities to get out of stuff and/or 'do whatever i want'
at WHICH point i just said 'you know, some of this stuff is sounding pretty ableist', and her response to that was that she was sure that if i needed a different modality of treatment that she just wasn't able to offer she was sure it was our there.

this is ALL OVER SOME MISSED APPOINTMENTS. for migraines, knee stuff, cramps, and one badly timed flashback anxiety thing - over the course of six months. like, there's no way i can plan when those things happen, and she has said multiple times she believes me, but that she feels i don't respect her time!!

i have made SO much progress with her with my depression. i have looked forward to every session for over two years. it would be such a loss. but being in her office today just felt crappy.

[radical]

You must feel devastated and I feel for you.

Does she charge for missed appointments where you haven't been able to give adequate notice?

You say you saw her for the first time in five weeks recently.  Did she drop this on you right before you went away?

Eleven percent of appointments is a lot, especially at twice a week.   If she's not charging for the loss, she would likely feel frustrated, especially if she is unable to schedule an appointment with someone else, so I quite understand her raising this.  What I struggle to understand is how she raised it.  You say you may have forgotten previous discussions.  Is this something you'd be likely to forget?  I know if a therapist raised an issue concerning financial loss and feeling disrespected by me, it would be engraved on my memory.

I know being unable to attend commitments it is an issue for people with chronic health problems.  Have you discussed this particular issue with her, (if she is out of pocket as a result?)

One of the things I find worrying is that she responded to your feelings about ableism with a kind of threat/suggestion that you can go elsewhere, rather than answering the question you posed.  Also her stated belief that you are malingering.  This is seriously troubling.

It sounds like this problem has been brewing for some time.  If she has not addressed her concerns assertively, but rather nursed grievances, become hostile and dumped her accumulated frustrations on you, she really isn't mentally healthy enough to be in the profession, imo.

My one niggling thought on the other side  is that you have missed an average of about an appointment a month for six months. I assume this would be pretty average for the previous 18 months unless your health has deteriorated. I understand that serious health problems could make this inevitable.  But if she has not been paid for one scheduled appointment per month, this would be an issue for her, a regular financial loss, yet you haven't shown any sign of seeing as such.  And she says that she has tried to raise this with you more than once, and you aren't sure if you might have forgotten those discussions.  I don't want to make you feel bad, this doesn't excuse her behaviour, it's certainly something she has failed to address appropriately.  Yet, if she has suffered financial loss consistently for two years and she has tried to raise the problem with you, but you have been unable to hear or remember, I can see how this could cause increasing frustration.  Just to give you some idea, in my country that would mean a net  loss of about $3600 over the two years.  It doesn't excuse lashing out, but it could help explain why this has boiled over.

No-one ever tots up the cost to patients of abusive or inadequate treatment, I know, so it may seem unfair to mention it, and it is only relevant if she has incurred a loss.

I'm sorry for how you must be feeling about this.  Are you going to try and repair this relationship?  It does seem like doing so would be very hard after what has happened.

[carnation]

 

Thank you so much for your thoughtful reply.   I opened a 'note' to reply to you as I read it!

I thought she DID charge for missed appointments, or at least a cancelation fee - which assuaged me ever-consuming guilt some - but turns out that billing insurance is 'illegal' and that 'practices never do that' even if they're paying privately - which i don't think is actually right - my (crazy NPD) mom had a private practice and I remember her having some sort of fee and me chiding her about never enforcing it.  Anyway.

Five week timeline: I had an appointment, the next day I got The Email, cried... like I was having a three day emotional flashback, decided to give myself time to figure out how I felt (haha), and after 2.5 weeks made contact - right when she was leaving town for 2.5 weeks.  We met when she got back.

I agree that she would understandably be frustrated, even with an understanding of my health stuff - "What I struggle to understand is how she raised it." EXACTLY. "I know if a therapist raised an issue concerning financial loss and feeling disrespected by me, it would be engraved on my memory." Pretty much anytime criticizes me it's engraved for oh maybe 10, 20 years and given the personal nature of this??  It would be immediate problem-solving time or I wouldn't be comfortable enough to move past it

I know being unable to attend commitments it is an issue for people with chronic health problems.  Have you discussed this particular issue with her, (if she is out of pocket as a result?)
Well, from the beginning she's known I get migraines, and when they come on, that's it, I usually tell anyone I'm going to have a regular commitment with on the first day about the nature of that.  My knee isn't exactly chronic, my cramps are only offing insane SOMEtimes, etc. 

One of the things I find worrying is that she responded to your feelings about ableism with a kind of threat/suggestion that you can go elsewhere
-i know!!!!!  not only is that disrespectful in a larger sense, it really hurt my feelings just for her to say that to me after such a long relationship

In reply to your longer paragraph at the end - no you're totally right to think about it in this way as well.  At one point in all this she pointed out that, not only does a same day cancel mean someone else loses an opportunity to have that time, but she's out $50, and "she knows I can't cover that."  While i AM on the far end of broke, i didn't appreciate her assuming that/not giving me a chance to work something out.  My partner could help me, and since my appointments are covered by state insurance, (approximately) $50/month for therapy is something I could probably swing. 

AARRGGHH.

I don't know what I'm going to do yet but I am extremely grateful to you for helping me think about it, radical, thank you.

[clarity]

Carnation...  

A therapist is employed by you to hold a safe space for you within which to heal.
This therapist has broken her contract with you and behaved very badly.
There are ways to handle this situation compassionately, and sending an abrupt email is not one of them.
The things she said to you are unacceptable and unprofessional.

Please be sure not to blame yourself for her shortcomings.... and whatever you decide, remember the above! 

[sanmagic7]

carnation, i'm with clarity all the way with this.  the more i read about how she spoke to you, what she said, not believing you, accusing you, threatening you - the more i believe she has a major problem and does not belong in a therapist's chair - at least not at this time in her life.

as a therapist, i was appalled at what you wrote about how she acted and what she said.  there are so many ways to address these issues with a client that would, as clarity said, keep the client feeling safe.  she missed them all.

i'm so very sorry about this.   too many neg. experiences with therapists have made people skittish about seeking help.  i'm glad she's helped you with your depression - maybe that's all she's got.  it happens.  still, she was wrong to come at you like that, to make you doubt yourself, try to make you feel guilty or sorry for her.  her problems are not yours to help with - it's the other way around.     hugs to you.