T, finances, pandemic...

So, T knows I am struggling with finances and it has always been a worry of his. IMO my household income should allow for it if H and I communicated better and set budgets etc. but H won’t. So I totally understand T not flexing on his fee. He clearly states he does not do a sliding scale. Those that do have a sliding scale would only offer a minimal discount if any based on our income so that is a mute issue for me. T does provide the paperwork to file out of network with H insurance but again, H has issues with that. So, again I do feel as though I can be upset with T when clearly there are things I *should* be able to do to afford to see him.
T has pretty strongly suggested going to every other week seeing as with the stressors of the pandemic he is only being supportive he doesn’t feel as though he is truly providing therapy (processing work for CPTSD). Pdoc thinks I should be seeing T a minimum of 2x/wk because of my level of trauma. The effects of the pandemic are super triggering as they mimic a lot of the neglect I experienced as a child. T is also, literally, the only person I talk to besides H because I don’t like phones/video chat... so I see him as more essential than ever right now.
I am processing a lot throughout the week but haven’t been sharing much with T because sessions are awkward in person, 6ft apart with masks on and Clorox wipes everywhere.
If I went to every other week I am afraid I would email him more, essentially taking up as much, if not more of his time without paying him for it. Then I feel guilty and ashamed of taking advantage of him... so If I went to every other week I wouldn’t allow myself to email more than twice which is my norm now. Again, in the big picture of my mental health I am not sure that is smart either. But if I run out of money now will I be able to do the trauma work later when things return to normal or will I not be financially able.

Yes, T and I are discussing this... most of the past two sessions were spent here, just looking for others thoughts.

Do you need permission from H to file an insurance claim? Is there a place you can put aside the therapy fee each week so that money isn't part of the general household funds?

Dear Omers,

I am so sorry that you are facing such demoralizing and difficult situations. It is heartbreaking. The SARS-Covi-2 must make it all that much more difficult. I hope things will improve for you soon!

Sincerely yours, Yao Wen

Hi, Omers.

I was listening to a podcast which touched on this issue - the role of the therapist within the pandemic.
One of the hosts seemed to suggest that it is absolutely OK for the therapist to provide much needed consistency during this time.
It seems to me that your T is aware of how much consistency he provides, but perhaps not of how crucial it is to you right now.

'Maybe there's nothing more to it than 'I'll be there at this time, you'll be there too.'

They also said that perhaps the midst of a crisis is not the time to pick it apart piece by piece.
That happens later, after everything has settled.

Still, it sounds like you are in a really difficult position. I hope you're able to find a way through.

Take care,

Lost

It sort of sounds like the problem is your husband, not your T or you. Can you talk to your H about making sure you're able to pay for what you need?

NP I currently have no income. I can get work but it is low pay, low hours and high risk. What I made in an entire year (with 100% availability) last year didn’t even cover the $140/wk for therapy. Sadly my earning potential has not increased and the available jobs would put me at high risk for covid19 and a years pay would not cover my health insurance deductible. So, I squirrel away any money I can but it isn’t much.
Thanks Yoawen.
Lost, I totally agree, especially as it is very triggering for me the way it is playing out. T is a self admitted project person. He likes seeing measurable progress, likes knowing his skills are being used and seeing a tidy finish... to which I chuckle and ask why the hell he became a T unless it was to frustrate himself!
Salmon, H is a huge part of the problem. We talked and he gave me the money for T... but then forgot the car insurance was due, the payment on the vet bill for the dog, dog food and cat food and groceries for us... but made other legit important purchases but not ones with immediate need. When I asked for money for groceries he just said we’d eat out which is SO much more expensive. So... over half the money for T went to necessities.... and my phone will still likely be shut off this weekend for lack of payment. Next week we pay rent which uses 2/3+ of the income.
If I can pull myself back up leaving H is a strong consideration.

I found this a sobering read. I am sorry that money is interfering in your therapy. I know that the "you-only-care-because-I-pay-you" sentiment is hackneyed and emotive, but when I read something like this, the financial transaction is brought into focus in a painful way. Obviously, he has to maintain a salary and he runs a business. Obviously, the financial transaction is an important boundary. If I couldn't afford a haircut, my hairdresser wouldn't cut my hair and I wouldn't blame her. But, jeez when you are working with trauma and pain and delicate emotional states and people's hearts, distributing care according to wealth seems so chilling. I think I find it particularly chilling because as I understand your relationship with your therapist, it has the hallmarks of a deep and loving therapeutic relationship. Money is a horrible bedfellow.

My therapist has a very generous approach to her fee and works with me for a nominal amount. I appreciate it, but it is not without its own issues. I feel like charity, I feel special, it highlights the class distinction between us, and so on. It fosters a feeling that I am not her work and that our relationship strays into another field. Of course, this is all symbolic for the wider boundary issues we experience and her sometime suspect practice.

It seems like money and therapy are fundamentally incompatible to me. At the very least, it is not a neutral transaction.

... That was a very long-winded way of me saying that I think he is being a knob for not working with you at a lower fee for a specified amount of time.

Thanks comrademoomoo there are a couple things I think are at play here. 1 he does not perceive me as taking the initiatives I need to take on getting a job (he sees me as well educated and employable but he has not looked for a job in 40 years). He also does not see me as taking the initiative with insurance because again, I am *smart* I*should* be able to figure it out... my attempts have not been successful and I don’t have resources to teach me. Sometimes having a high IQ and perceived as smart is a huge disadvantage because people assume that you are smart about everything or that understanding comes easy for you. T even made the mistake of “Justing” me the other day and had to be reminded that was no different than “shoulding “ on someone.
On the flip side the only thing he was limiting was face to face sessions. He did not suggest limiting emails or phone calls. Personally, I would feel inappropriate seeing him half as often and calling or emailing twice as often or more. An odd difference in values I guess?
I do find myself disappointed but again it his financial policy was clear from the beginning.

There is another T with similar skill sets not too far away that offers far more flexibility if I needed to make that choice, or just as support through this bump and then back to T for trauma work. And, I don’t know if T would go for it but there is another T in the building that is less expensive that might work for just support... I couldn’t ever do trauma work with that other T but they would be good support. The three of us have joked in the waiting area and I know my T and the other T from the same office have talked at least briefly of me (with my permission) as a consultation type thing.

But yeh, the money part sucks. My T’s being nieve about some things is a bit annoying too.

You shouldn't have to "earn" the offer of a lower fee by successfully completing certain activities like job searches and insurance claims. A sliding scale is based on ability to pay/income not on how capable someone is of carrying out administrative tasks. You are right though; not offering the lower fee is justifiable as a business decision and he has put a definite boundary in place, as he is entitled to do. To me, it seems inflexible and lacking in care for him to act like this, especially as it means you would have to halve your face-to-face time despite the fact that you clearly really value that kind of contact.

Also, H said about a month before the financial “difficulties “ started that “T has you convinced that he loves you and cares about you but as soon as you aren’t paying him all that will go away”... which is Hs jealousy but it does make me question where the money is going.
T has already told me that he recognized early on how significantly I bond with people I choose to allow into my life. T recognized that I am still in touch with teachers and such from 40 years ago and love them like family, but I will honor what ever boundaries they set. T has already committed to allowing some kind of connection for life... not therapy, not necessarily friendship but contact and connection... so I know the love and care won’t stop no matter what.

I'll comment more on the other stuff in a separate post, but are you eligible for unemployment?

Hi LT, I am not currently eligible for unemployment as I left my last job “willingly” due to an injury. Once the unemployment offices open up though I can get other benefits (classes and certifications and such) to update my resume and allow me to get a much more stable and appropriate job... I am good at a lot of things that aren’t on my resume in any way... so if I can get into classes at the job centers then I can be certified in what I already know lol. But I have to wait for my state to open up more.

Hugs, this really sucks... I feel lucky in that Dr. T has a sliding scale and will go quite low for some clients, apparently (mine's slightly reduced because of changes in my insurance reimbursement that started last year). He's said he's greatly reduced the rate for some who are out of work right now because he doesn't want them to have to go without therapy. (Which shows a particularly caring side of him...) When I asked if he was taking any time off coming up, he said he's trying to work as much as he can, partly because of that, and also partly because a couple practitioners he leases space to (like a massage therapist) can't pay him right now, so he's a bit concerned about being able to pay his lease (he leases a bunch of offices and waiting room, then rents them out to others, including my D's T).


So it could be a concern like that for your T, like would he have to give up his office space? It's clear he really cares about you, and I hope maybe you could work out some sort of arrangement. Like, is it possible you could carry a balance with him for now to pay off in the future, once you can look for work again? Less good option, but still possible--could you put it on a credit card to pay off later? It would just suck to have reduced support right now...

Or could you create a sort of budget with your H, where, after the regular expenses (like housing), you each get a certain amount each month, and you can do whatever you want with that money, no questions asked?

Oh, that sucks...that would be good if you could get classes and things though.

T says his caseload has not gone down any when we were talking about how much more stressful teletherapy is for him. I am confident that if he is not more open to work with me financially that he is not doing it for other clients either. He did mention being a little behind in some expenses but he didn’t elaborate. He gives every indication of being very good with finances so I assume it is no fault of his, that there was something out of his control. I know he has had several Minor health issues lately and I know how, even with insurance, this can add up. He does rent space to two other T’s in his building but obviously the details of that are not any of my business.
H is too unreliable. We make plans and then I follow them and he forgets something... like groceries or pet food that we obviously can’t just skip... so then I take away from my needs to make sure that the humans and pets are fed. I am currently trying to figure out if he really is that daft or if it is intentional. Today I am leaning towards daft as he is insisting Memorial Day is two weeks away.
I am already using credit cards to fix the lag between when I see T and when H gives me money (H honestly never pays up front for anything unless he is like on his death bed and there is no other option). But, with H not coming through with the money and the interest charges the cards are making out quickly.

T also does not see what he is currently doing with me as therapy or trauma work. From around 5th-9th grade I was severely neglected in ways that are completely triggered by the pandemic and the stay at home orders. We were just starting to figure out how to safely process that time in my life so it is not on my timeline with T and we haven’t really talked about it. Unfortunately I have also reverted back to handling the stress the same ways I did at that age... which was to hide it REALLY well. So T honestly does not have an accurate picture of how I am doing, he has no clue that I am basically totally reenacting that abuse... and I have not yet found a safe way of explaining it to him. Our “rule” is that my anxiety over disclosure is not to go over a 5 on a scale of 1-10. If I were to “just tell him” I would disintegrate to a level where I would likely need hospitalization (aka a 15 on that 1-10 scale). I have tried hinting at what I can with out overloading my stability but he isnt getting it and with me just hinting it isn’t fair to expect him to... it isn’t like it is normal types of abuse that one could just guess. Aaaaand... the “part” of me that is developmentally stuck there we call “13”. H HATES 13 and has made it completely clear she is not welcome in his home, he didn’t marry no 13 year old and he isn’t dealing with “her” BS. So... I have to know I can 100% contain between sessions.
All I can think of is my last T who called things like this “messy” and she didn’t have the time or energy to deal with “messy” so I couldn’t schedule with her until I got everything tidy and under control again. Current T knows and respects her as a T so I don’t talk about it much. I know current T wouldn’t do that but it sure feels like it right now.

Oh, and T’s reaction to H saying he had no tolerance for 13 was to go to a domestic violence shelter.

You say something about "when H gives me money". Do you have any access to your financial accounts? You might want to google financial abuse.

We have never had shared accounts. In hindsight I realize that H used up all my financial resources a long time ago. I was too nieve to catch on. Now the only money is his income, in his bank account that I don’t have access to.

It can be both. I've known a few people who were often doing stupid stuff, getting in trouble, and getting someone else to pay the bills. Why bother to be smart when someone else will fix your problems for you?

Most bank accounts will let you set up regular, automatic transfers to another account. Maybe you could try doing that with your H? so you don't have to ask him for money or remind him all the time.