Last week S.M. contacted me with a name of a potential therapist. The one we’d spoken about before for the consultation wasn’t available. I googled this person and was very uncomfortable about meeting with her because she’s a member of a small organization that a large number of people I work with are also part of. The connection to my work was way too close.
I articulated this to S.M. and he was insistent that I needed compromise somewhere with my confidentiality concerns. He wants me to meet with someone even if I am worried about their association with my work and then work through those concerns in the therapy. There’s just no way I could feel comfortable enough to even begin therapy with someone so closely associated.
I believe I made the right decision here and feel further reinforced with this by the fact that at my work this week, the organization that that therapist is a part of came up in a meeting. We are inviting this group to an event in the near future. The organization already contains 1 past therapist from several years ago before I began this job. Had I agreed to meet with this new therapist I might have been dodging 2 past therapists at the same event. Hopefully that one therapist won’t attend this event.
S.M. told me that he’d run out of resources and that he would call this therapist if I wanted to meet with her, but otherwise I needed to find a therapist on my own.
I feel horrible. I feel guilty for bothering him so many times about referrals. He’s really gone above and beyond with finding me therapists in the past so it’s not fair to feel angry at him. But I am a bit angry. I was holding myself together with the hope that he’d find me a therapist and it fell apart.
Part of me wanted to call him apologizing for bothering him so much, but I didn’t because I realized the apology would be a little passive aggressive.
I found one last local place to try to call. They didn’t have availability until January. I can’t wait that long. I had a panic attack while on the phone. I was such a mess, that the secretary put me on hold, saying that she’d try to find someone I could talk to right then on the phone. At some point the call was dropped. I tried calling back, but they had closed for the day.
Per the suggestion of some folks here, I decided to expand my search radius. I discovered that Second-Closest-City is easier to get to than I’d realized. It’s actually easier and faster to get to this further away city than to a lot of the suburbs surrounding my city. This city is far enough away that people are not all affiliated with where I work.
I made a lot of phone calls. Nothing was working. I can’t count how many panic attacks I had. I skipped out on a lot of obligations, because I was too upset to leave my apartment.
I was working on my next suicide method and kept calling my Dad crying. He took over the search for me. I hate having my Dad do these things for me. He’s very busy and I am really trying to pretend to be an adult. But I was falling apart trying to manage it myself.
My Dad found someone for me to meet with who was able to see me a few days from then.
On the day of the appointment I traveled to Second-Closest-City. I’ve traveled through Second-Closest-City many times, but I can only think of one time when I was maybe 12 that I actually visited it.
I was very prepared for my trip. I put together a whole packet of maps and train schedules. I decided I would walk, but spent 20 minutes getting lost and progressively more anxious. It’s scary coming to a new City and not even knowing where the main streets are. I asked a stranger if she knew where I could get a cab and she gave me the number of a cab company.
I waited for 10 minutes, no cab arrived. The time of my appointment was rapidly approaching, and I was worried about waiting for a cab that might not ever show up. I backtracked to a more populated part I’d walked through earlier and found a cab.
I really don’t like taking cabs. It goes against the whole don’t get in a car with strangers idea. I know a number of people who’ve been held up by cab drivers and some who cab drivers attempted to rape. I’m a very tiny person, I wouldn’t be able to do much to protect myself.
Also in a strange city sometimes it can be hard to distinguish legitimate cabs from illegitimate ones. This one was particularly shady, but I was desperate. It had a meter which added some legitimacy to it, but it was very run down and the driver gave me the creeps.
I safely made it to the building where the therapist is located. I had traveled 2 hours from the door of my apartment to the door of his office to discover that he has a buzzer at his door.
He directed me to a waiting room, which wasn’t really a waiting room. It’s clearly a room he usually uses for group therapy sessions. The chairs were all arranged in a circle. At first I thought he was going to conduct the individual session in there! There would have been a lot of empty chairs available for the empty chair technique.
The actual office was more typical, although it was meticulously organized. My first impression of him is that he dresses more like a lawyer than a therapist.
He commented on my outfit and asked if I was still dressed for Halloween. I let him know I dress like this year round. A tactless early comment, but I let it slide.
The first session went well enough that I returned again for a second appointment.
The second appointment went less well. My trip to Second-Closest-City was nice. I conveniently was able to take the same train as a friend who commutes daily to Second-Closest-City. This friend is someone who doesn’t know any specifics about my crazy, but I am comfortable enough with that I shared my reason for going to Second-Closest-City with him. I have a lot of trouble justifying social interaction in my schedule. If nothing else this trip can force me to communicate with another human for a bit.
My friend and I shared a cab, because the weather was bad and he was traveling in the same direction.
I arrived at the office with 3 minutes to spare. A big change from my usual 20 minutes early, where I avoid going into the office until at least 10 minutes of.
He was dressed less like a lawyer this time, but I have a serious comment for you folks: Do not wear brown shoes with a black suit. Fashion disasters make me sad.
I brought my collection of neuropsychological testing to the appointment. The therapist had seemed a little uncomfortable about writing my Ritalin prescription and asked if it could wait until this 2nd session. I figured I should bring the testing so he’d know I wasn’t inventing the ADHD diagnosis myself. I’m really worried that my decision to go so far away might be misinterpreted as something drug seeking.
I’ve given many of my therapists copies of my testing. Some are more interested in others. Based on his questioning from the first appointment, (He asked a lot of neurological and general medical history type questions) I thought he’d want to see them.
I don’t have a good way to make copies. I could theoretically do it at school or work, but I don’t feel comfortable copying my personal private information there. So I brought the originals and asked if he was able to make copies.
He said he could make copies there and proceeded to do so. For the next 15 minutes. The copier was misbehaving. He unstapled and restapled all my reports. Papers were put everywhere. I have to check through all my reports now to make sure no pages or entire reports are missing.
It felt very disrespectful of my time. Yes the therapy session is only scheduled for 50 minutes, but I have to carve out 5 hours in my day when including travel time. If I’m waking up at 5:30 in the morning to begin my day so I can fit this in, then I’d like to get the full 50 minutes.
I get that he might want to avoid having tasks for patients outside of the billable hour, but despite his similarities in fashion choices to a lawyer, therapists billable hours don’t usually work the same way. Their fee should partially factor in doing some tasks outside of the session. This is why the hours are 50 minutes rather than 60. Every other therapist who I’ve given reports to has made copies and given the originals back to me the next session, rather that using session time.
It’s possible that he just didn’t realize how much trouble he’d have with the printer, so it took longer than expected. But I found a similar trend in the 5+ minutes spent discussing billing. He mentioned that I’d not brought a check the first session. I hadn’t realized he wanted me to. I thought he was going to bill my Dad. I asked if he could just send my Dad the bill. He wasn’t very into this idea. he really wanted to sort it out right there.
It turns out he takes credit card. I paid with my American express card. American express has a reputation for charging a lot in fees to vendors. I hope he got charged a lot in fees for being too lazy to send my Dad a bill. I get that maybe a lot of patients don’t pay bills promptly, but my Dad is very reliable about these things. I’m not sure if my credit limit can handle getting too many of these charges. I usually just use it to buy food.
It makes me really anxious to see the sticker price of sessions. When I submit it to my insurance company for reimbursement the cost will go down to 15-20 dollars per session, but to see $500 for the two sessions on my receipt makes my heart rate speed up.
This left less than 30 minutes of therapy time.
We had a very uncomfortable interaction where he asked me if I wanted him to help me. He wanted me to say “I want you to help me” rather than me just answering his question with a “Yes”. I didn’t cooperate.
This and a couple of things made him feel more like a bad “self help guru” than a psychiatrist. He listed the 5 things he felt were important in a psychotherapy session and the 3 types of communication he believes exist. It felt trite and cheap and tacky.
The session was very directed towards talking about my childhood. I certainly do believe that my childhood had a role in the types of problems I have today, but he doesn’t even know yet what most of my problems today are. It’s too easy for this type of therapy to turn into time where I just say horrible things about my parents. And my parents (especially my Mom) definitely messed up in some places, but they were well intentioned. I did not appreciate his efforts to make me express anger about my Dad for a situation where my Dad really had no good options. He’s paying the bill! and basically is a good guy aside from his inability to be emotionally supportive.
I mentioned that I am not going home on Thanksgiving and the therapist reacted much too enthusiastically about this. He hardly knows my situation and reacted as if I was cutting ties from an abusive family situation. My family is dysfunctional in many ways, but not abusive. My reasons for staying here are more academic than emotional.
I much prefer information about growing up to come out organically in relation to information I share about the present. I am suffering here in the present. Yes the past influences that, but the present matters too. Dwelling on every detail of my childhood is not conducive to changing how to feel today. Really, it just makes me more miserable.
Is it unfair for me to seek out a psychodynamic therapist and criticize him for wanting to talk about my childhood too much? I don’t think so. I think a therapy can be dynamically informed while having a present focus.
I mentioned how I’m not fond of the pure free association type of therapy and I prefer when it’s more interactive. He said that he agreed and said that he’d once been in therapy with a classical Freudian-type and had hated that style. I am kind of uncomfortable with that self-disclosure, even though I realize it’s very typical for analytically oriented therapists to have had their own therapy at some point. It felt like over sharing.
When working on the billing, he asked what ICD code I wanted. I’ve been asked in the past what diagnosis others have used for the bill, because they want to be sure I get reimbursed, but never flat out asked which code I wanted. I opted for Major depression, recurrent, moderate, because I’ve had that used a lot in the past.
I’ve been trying to do work on the train, so I don’t feel the time is wasted, but unfortunately I’ve been so tired, that I’ve not been very productive. Maybe as it becomes more routine it will be easier.
I’ve been having a lot of reactions to the idea of going to Second-Closest-City for therapy. When I was calling places looking for a therapist, they’d ask where I coming from and I’d tell them and as soon as they wondered why I’d come so far, I’d start crying. I’d hardly be able to speak.
I feels like it’s some kind of punishment for being so crazy. I’m so messed up I can’t even find a therapist in a city filled with therapists. 3 of my former therapists are within a 5 block radius of my home.
I’m mostly keeping these trips private, people would think it’d strange for me to go to this Second-Closest-City for a couple of hours only. I feel like I’m going on these secret adventures that I can’t tell anyone about.
Some of my professors commute from Second-Closest-City to my city. I have a slight fear that because I am taking such an early train that I might run into them at the train station in Second-Closest-City. I’m not sure how I would explain seeing them there, then seeing them in class later that day. It’s close enough for a commute, but far enough that people don’t usually just stop in for the morning.
There are some upsides though. If I were to be hospitalized, I’d be hospitalized there and my confidentiality would be safer than it could be in any hospitals around here.
I also feel like in this other city, I am suddenly free from a lot of my worries about privacy. I’m in this city where hardly anyone knows me. It’s liberating.
I have some serious doubts that #26 is going to work out. I’ll give it one more appointment to see if things improve, but otherwise I’ll move on. If nothing else I’ve learned that Second-Closest-City is a viable option for finding therapy.
Wow, quite an adventure you have had. I’m sorry this is so difficult for you. Life itself is very difficult, finding help for our personal journeys should be a little easier. Unfortunately it doesn’t seem so. It’s too bad you haven’t clicked with #26, but maybe next week will go better.
Your comment about the shoes resonated with me! My t wears a lot of navy blue. And he always wears brown shoes with his navy blue slacks. I would much prefer black shoes. Or cordovan. Maybe that’s just me?
Yea, #26 really isn’t working out. I already made that next appointment and have too much to deal with this week to handle the instability that comes from firing a therapist so it makes the most sense for me to at least go to one more appointment and see what happens.
Oh no. I don’t like navy blue with black :( I’ve had therapists who wore navy blue socks with black everything else and it looked really silly.
Navy blue socks with black? Ick. My t’s socks always match his pants. I just don’t like brown shoes with navy pants.
The fashion comments are cracking me up. I love it. :-) Sorry you’re having to work so hard to find a therapist. I can’t even imagine. I drive about three miles to see my therapist and I am not sure I would even go if I had to drive farther…or take a train!
I wish I could just find a therapist who would work out. I was sick of this process 3 yeas ago. I just doesn’t end. Maybe I just need to move back to where S.M. is, but I have to get a job there and finish school first.
It’s tough because I know looking at this problem from a birds eye view that this difficulty is related to my avoidant attachment style. But looking through my list of each therapist individually it doesn’t feel like that. There are always reasons why it isn’t working out with this particular one and it is a bad match.
Isn’t it so strange how when you are in that fight or flight mode you not just looking for the perceived sword but looking at some dude’s socks and tacky shoes…it is like you are out of your body with panic but still in there totally calm and cool and collected saying in a Holly Go Lightly voice, “Hmmm, that just is not quite right.”
When I get stressed I tend to looks for patterns and notice when things don’t fit. Things that are aligned funny or don’t match. With a former therapist I’d start sessions by listing objects in his office that had moved since the last session.
This is absurd! How many people do you have to get through to find someone who is a good fit for you. :( I know some people go through several and you are in a particularly tough spot because of your work. I feel sooo bad for you :( doesn’t help though, to say as much.
Good for you for trying another city. I can’t believe your bill was $500! Has this been the most you’ve paid for therapy? Is it because he is a psychiatrist? Have all your therapists been psychiatrists? Would you consider seeing someone who isn’t one and either seeing a psychiatrist on the side just for meds or asking a GP for meds? I know it’s different elsewhere, but here psychiatrists are trained in meds and while they may do some therapy-type work during an appointment, that is not their forte. Does that make sense? Maybe if someone wasn’t focussed on the meds so much, they could focus on you?
500 for two sessions so 250 per. SM is 300 per so Ive paid more. Insurance reinburses most of it and usually bills go direct to my dad. So what made this more unusual is that the payment is going more directly through me even though ultimately it will be a 20 dollar per session cost.
Yea I see mostly psychiatrists and they do cost more. I don’t see much of that cost increase though because of insurance. When I split care Btwn two people I’ve had problems in the past. Plus my refills are sporadic because I only take prn meds. So I’d have to see this med only person once a month where they’d do nothing because I only need refills like once every three months.
It does help to say it. I go through this whole therapy journey in secret and the people reading this blog are among the few constants I have with it
OMG. I cannot even believe some therapists charge that much. That’s insane! How are they able to keep a full load of clients?
Perhaps you’d have more success by branching out of the psychiatrists for therapy? It’s interesting because most Psychiatrists here in LA don’t do therapy at all. I have a therapist and a psychiatrist.
The way a lot of these therapists work is that they work two places. One is a low cost hospital clinic that takes insurance the other is their private practice where they either do not take insurance or have a quota of how many insurance people they will take. The problem is that the hospitals always have waiting lists that are very long. But the reason the waiting lists are so long is partially because the therapists are mostly part time. When I first started my adventure of trying to find a therapist I’d try by looking at the insurance providers list. I’d call everyone on the list and no one was available. Then when I switched to paying out of pocket and then getting reimbursed by insurance suddenly it was easy to find therapists who were available. This isn’t an option for everyone because it requires putting a lot of money upfront first and not everyone’s insurance has as high reimbursement rates as mine. It’s messed up, but basically insurance pays inplan providers next to nothing so they often avoid taking only insurance patients, because the people paying full fare out of pocket are very valuable to them.
Just popping in to say that this…
We had a very uncomfortable interaction where he asked me if I wanted him to help me. He wanted me to say “I want you to help me” rather than me just answering his question with a “Yes”. I didn’t cooperate.
… is some manipulative bullshit. What the hell? What’s the purpose of a conversation in which one person controls the response of the other?
I like a bit of a commute; lets me between therapy and real life. If you meet one of your professors, could you just say you “had an appointment” and pretend like you were seeing a gynecologist? They ought to know not to question that further anyway, being in the mental health field. (But then, you’ve had your privacy breeched so i understand why you’d be skittish.)
Yea it was very manipulative and that combined with his over excitement about me not seeing my family for thanksgiving made him give me a bit of a cult leader vibe.
the commute lets me _transition_, that is =)