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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Tabitha on December 19, 2002, at 3:03:07
Every so often I panic over how much I spend on therapy. It's thousands per year, and has been going up. I have the last appt of the day, and my therapist will do 2-3 hour sessions with me. Plus she does phone sessions, yet I've cut down on that. All this at $120 per 50 minutes. It's getting to be over $10,000 a year out of pocket, though I do tax deduct that amount.
I have a good income now, but I can't help think how my life could be different if I was not spending the money. I could afford double the mortgage payment, meaning a way nicer house or location. I could have a much better "stuff" like clothes and furniture. A new car every 2 years. Or the really appealing option-- I could save more and retire sooner. My profession is not kind to older workers, so I never really feel secure. I keep imagining I'll be old and unable to afford decent meds because I've not saved enough during my earning years.
I keep telling myself I should limit the length of the sessions, but it just feels so good to unload all my stresses in therapy. I just start in with everything that's bothering me, and before I know it 2 hours have passed.
It seems like I need the high-stress job to afford the therapy, and I need the therapy to cope with the high-stress job. I'm a hamster in a wheel.
I wonder if it's really helping. My therapist of course says I'm improving, but I feel stuck. Even if I am improving, that's not proof that the therapy is helping. It seems like I'd have to quit to be able to tell whether I need it or not, but then I'd lose my time slot. Plus I'm afraid to quit, because she's my lifeline at this point, the only person who really consistently makes me feel better when I talk to her. I know it feels good, but is it really improving my life to talk about my problems so much?
I imagine if I just stopped going, I'd be forced to find resources within myself to cope. Or else I'd do worse.
I've been seeing her for 9 years now. Or is it 11? I'm afraid to check my calendar.
I tried support groups but it didn't reduce the need for therapy time. It might have even increased it, since the more interaction I have with people, the more I need to process. It seems like the only solution is to go on a self-deprivation therapy diet, and force myself to limit the time per week. What a terrifying prospect.
Posted by Miller on December 19, 2002, at 8:51:48
In reply to spending a fortune on therapy, posted by Tabitha on December 19, 2002, at 3:03:07
Tabitha,
Is there a chance you could compromise instead of depriving yourself? Such as telling your therapist that you need a couple of months off, but schedule another session in your time slot for a specific date two months away.
Also, have you considered maybe trying to find "coping skills" that don't involve therapy? Maybe if you make an appointment to another (unknown) therapist and ask about what you have done, and where you would like to be, a non-partial professional could give you different directions.
I hope this helps you think it all through. Good luck to you.
-Miller
Posted by justyourlaugh on December 19, 2002, at 10:20:21
In reply to Re: spending a fortune on therapy » Tabitha, posted by Miller on December 19, 2002, at 8:51:48
hi tab
in canada its all paid for by the government.
my sessions are started and ended without the clock.
my pdoc has never labeled me.
nor does he beleive that i should rely on him for
"wellness".
he calls our appointments"touching base".
i know its all up to me(he did keep me in the hospital for 6 days though)
its alot of pressure this way but i can change for the better.
i want more than this!
then again mabe he is to busy for me..
or he is an ass?
jyl
Posted by ROO on December 19, 2002, at 11:51:45
In reply to Re: spending a fortune on therapy, posted by justyourlaugh on December 19, 2002, at 10:20:21
Tabitha...I know the feeling....
But I would say, just from your latest post on
PSB responding to Bookgurl on friendship, since you don't have a lot of close friends in
your area that you can really be yourself with and disclose
with (you did say that didn't you?)...that it's best to stick
with it for now....maybe when you've built up more of a support
network, you can ditch or cut back on the therapy. Personally,
if I don't have that one person I can _really_ talk to at least once
a week...I start to lose perspective and down spiral. That's just
me. But you've been doing it 9-11 years, so who knows, maybe you're
ready....but I would just be sure you have a good support network...folks
you can really talk to, deeply, profoundly, about your inner world, before
you cut things off with the shrink.
Posted by Dinah on December 19, 2002, at 12:38:15
In reply to spending a fortune on therapy, posted by Tabitha on December 19, 2002, at 3:03:07
I really know how you feel. Since my second to last meltdown, I've had regular twice a week sessions. (When Mr. Stability isn't going out of town for his other job.) That's not only $110 twice a week, but it's also 2 1/2 hours of my very limited time twice a week. Since a lot of my stress is job related, my time might be better spent doing my work then instead of at night.
So I was all ready to talk to him about paring it down to once a week when I realized that the reason I'm doing better is *because* I'm seeing him twice a week. No matter how I feel, I seem better able to avoid a meltdown because I know I'll be able to talk it over with him in a couple of days, while a week sometimes seems endless to my immature self. That promise of safety and release twice a week seems to be settling for me.
Plus, for the first time in the almost eight years I've been going to him, I think we're making real progress in my becoming aware of my feelings with the goal of becoming more integrated. Once a week seems to lose the momentum a lot.
Down side is that I'm not at all sure it's safe to be so dependent on him.
So I don't know. I may try trimming to once a week and seeing if crises start to develop.
Have you talked this through with your therapist? (ironic question, isn't it?)
Posted by Dinah on December 19, 2002, at 12:41:45
In reply to Re: spending a fortune on therapy, posted by justyourlaugh on December 19, 2002, at 10:20:21
> its alot of pressure this way but i can change for the better.
> i want more than this!
> then again mabe he is to busy for me..
> or he is an ass?
> jyl
>
My guess would be neither. It's the system. You guys in Britain and Canada don't have to pay, but from the posts here, you just don't seem to get the level of service that those of us who are fortunate to be able to pay get in the United States. I realize that there are many people in the US who would be better off under your system.
Posted by Nikita on December 19, 2002, at 14:36:23
In reply to Re: spending a fortune on therapy, posted by Dinah on December 19, 2002, at 12:41:45
Tabitha? Do you have health insurance? Mine covers my sessions with both my pdoc and my therapist. I have to pay a $15 copay each time but that's it.
Posted by Eddie Sylvano on December 19, 2002, at 15:01:30
In reply to Re: spending a fortune on therapy, posted by Nikita on December 19, 2002, at 14:36:23
> Tabitha? Do you have health insurance? Mine covers my sessions with both my pdoc and my therapist. I have to pay a $15 copay each time but that's it.
Expense is a lot of the reason I've avoided going to therapy. My health plan only covers 6 visits per year. I'd be impressed if I could be cured in that amount of time :)
Posted by pinkeye on December 19, 2002, at 16:42:22
In reply to Re: spending a fortune on therapy, posted by Eddie Sylvano on December 19, 2002, at 15:01:30
Hmm.. if you have spend nearly 9 years in therapy, why don't you try to muster enough courage to go on your own for a while? My doctor always says therapy is meant to help people help themselves and not rely solely on therapist life long.
PinkEye.
Posted by Dinah on December 19, 2002, at 23:02:57
In reply to Re: spending a fortune on therapy, posted by pinkeye on December 19, 2002, at 16:42:22
Aggh!! Don't scare me!
Seriously, I'm my therapist's only this long term client (I think). I finally summoned up the courage to ask him if he was planning to kick me out because I hadn't gotten better. He said the general idea is that you don't stay in therapy this long, that you learn to cope on your own and only come in for new problems. He said he'd be a pretty rotten therapist if his clients routinely came in for depression or anxiety and were still here 6 years later (I think that was how long at the time). But he said most therapists have one or two long term clients, and that as long as I found it helpful he wouldn't *gasp* terminate me. We've had several sessions over the year or two since where we re-evaluate this plan.
I'm not sure what that means about my mental state, that he considers me worthy of lifer status (grin). But I think it's a combination of the long term biological nature of my disorders (coupled with my desire to keep meds to a minimum due to unwanted side effects) and probably some sort of personality disorder, combined with a lack of a social support system. We both see it as similar to insulin for a diabetic, or as an alternative to increased mood stabilizers or anti-depressants. It helps keep my stress level down and thus keeps my illness at a manageable level and me pretty much at least minimally functional.
Before I mustered up the courage to ask him, I did a lot of research on long term supportive therapy. Not that that's all we do, but it's a big part of it, bigger at some times than others. So I guess the term of therapy depends on the therapist's orientation (but mine is oriented to short term for the most part), the goals of therapy, and the needs of the client.
Posted by Tabitha on December 20, 2002, at 0:14:09
In reply to Re: spending a fortune on therapy » pinkeye, posted by Dinah on December 19, 2002, at 23:02:57
To those who asked, I do have insurance. It's actually really good right now, but I use so much time, even with all they pay I still spend a lot.
In general I believe in long-term therapy for growth. I think of it as continuing education. I also agree with the maintenance idea. I know even with meds I'm still vulnerable to setbacks brought on by stress, so I need extra support (which I currently don't have anyplace else). I don't really mind the feeling of dependence (at least I think I don't). It's just such an expensive service to be dependent on, and my need shows no sign of decreasing after all this time. I keep thinking what if I quit, and then see it completely differently, and have regrets. You know how you can be stuck in a crappy love relationship or belief system for ages, then once you get away from it, you get perspective, and see how it wasn't really so great, and how much it was really costing.
Yet I feel like I'd die without it. I just get this huge feeling of pressure from events (mostly work right now). If I didn't have the outlet of the sessions, I don't know what I'd do.
Well you get the picture -- I'm conflicted!
And I do talk about this stuff with her. Which is of course absurd. Maybe this is just the new cloak of my resistance. For the first several years, I was constantly having an internal argument about whether I should be going to therapy at all. I'd go in with my complaints about therapy to her, and she'd just put out there her reasons for thinking it was helping me, and they didn't really sink in, but at one point I just decided to have faith in her. Long after that, I noticed I no longer had the internal struggle about it. I think what happened is that it started feeling like a relief to go, instead of feeling like it was just stirring up more pain. So for many more years, I just went on auto-pilot because it felt good to go. Now my only reservation is how much I spend.
I'll be shopping or something, and be reluctant to spend $20 on something, and the contrast just hits me between that and how much I rather thoughtlessly shell out each week for talk-time. It seems so shameful! Maybe it's the old entitlement issue again-- that voice that says I don't deserve so much support, even if I can afford it right now. Like shame on you, you shouldn't need so much therapy.
As I type this, I'm thinking shame on me for such a long post! And for being so confused. Sheesh.
Posted by Dinah on December 20, 2002, at 5:08:48
In reply to Re: more info..., posted by Tabitha on December 20, 2002, at 0:14:09
I could have written much of this post myself.
> I keep thinking what if I quit, and then see it completely differently, and have regrets. You know how you can be stuck in a crappy love relationship or belief system for ages, then once you get away from it, you get perspective, and see how it wasn't really so great, and how much it was really costing.Yes, I understand that. How do you really know unless you quit? My therapist would take me back, so I wouldn't have the fear of losing him (I've fired him a half dozen times in the earlier years, so I'm pretty sure he would.)
>
> Yet I feel like I'd die without it. I just get this huge feeling of pressure from events (mostly work right now). If I didn't have the outlet of the sessions, I don't know what I'd do.But the thought of quitting, even for a while, terrifies me. I do have the periods of time while my therapist is out of town, and that gives me some idea. I go on autopilot and shut down emotionally I think (with periodic meltdowns from suppressed emotions). Would that change over time? Maybe, but it sounds like my life before therapy, so I'm not sure.
>
> Well you get the picture -- I'm conflicted!
>
I know the feeling!!> And I do talk about this stuff with her. Which is of course absurd. Maybe this is just the new cloak of my resistance. For the first several years, I was constantly having an internal argument about whether I should be going to therapy at all. I'd go in with my complaints about therapy to her, and she'd just put out there her reasons for thinking it was helping me, and they didn't really sink in, but at one point I just decided to have faith in her. Long after that, I noticed I no longer had the internal struggle about it.
Sounds familiar to me. :) I caused myself a lot of pain. I think that in me it was the push/pull fear/attraction of a level of connectedness that was scary to me given my history of pain being associated with connection to others.
>
> I'll be shopping or something, and be reluctant to spend $20 on something, and the contrast just hits me between that and how much I rather thoughtlessly shell out each week for talk-time. It seems so shameful! Maybe it's the old entitlement issue again-- that voice that says I don't deserve so much support, even if I can afford it right now. Like shame on you, you shouldn't need so much therapy.OK, you lost me there. I'm not great at managing money in any area of my life. :)
>
> As I type this, I'm thinking shame on me for such a long post! And for being so confused. Sheesh.((Tabitha)). You still need to treat yourself as compassionately as you treat others.
Dinah
Posted by Dinah on December 20, 2002, at 5:10:07
In reply to Re: more info..., posted by Tabitha on December 20, 2002, at 0:14:09
Posted by Tabitha on December 20, 2002, at 22:28:04
In reply to Re: more info..., posted by Dinah on December 20, 2002, at 5:08:48
Thanks Dinah. Your post made me all teary. You're the greatest.
Posted by ShelliR on December 22, 2002, at 0:07:32
In reply to spending a fortune on therapy, posted by Tabitha on December 19, 2002, at 3:03:07
Tabitha,
I wouldn't suggest that you quit; but is it possible to set a limit on your session. It almost seems like a conflict of interest to me that your therapist allows you to stay as long as you want, because you're her last appointment.
What about if you set the session for a session and a half? That way, you are getting some extra time, but it's still under control.
btw, I was with the same therapist for many years and I also thought I'd die if I stopped seeing her. Finally she decided to start traveling with her husband and I was forced to leave. It wasn't nearly as difficult to change therapists as I had anticipated, and I felt I even benefited from the change. (I had been feeling that things had been stale for a while, but I couldn't imagine being without her; I felt so much that she loved me and really cared about me.)
Now, years later, I am much more inclined to look for a therapist who helps me set goals and figure out how to go for them. But probably I needed a non-directive therapist for a long time first, to feel that someone cared about me, since I didn't get that from my own mother.
Shelli
Posted by Medusa on December 23, 2002, at 1:41:44
In reply to Re: more info..., posted by Tabitha on December 20, 2002, at 0:14:09
Toughie.
Have you looked into different types of therapy? I spent years in "talk therapy" - I don't know what the official name is for it.
One option might be to take a break from this therapist, do a round with a short-term approach therapist, and then go back to your regular talk therapist. Family Systems therapists, around here anyway, tend to see patients 3-5 times, once a month, and then they've done their job. It's intense. Lots of homework. (Letter writing and other assigments.) I can look up links if you like.
A good career coach might also be worth a round during a vacation from your regular therapist. Costs about the same, and it could be that some of your "issues" that seem to be interfering with your job, might actually be diminished in a job that better suits your soul. I don't mean fundraising for United Way or working for a non-profit. Just a better environment in your industry or a similar one.
Posted by Sebastian on December 26, 2002, at 16:01:30
In reply to Re: spending a fortune on therapy » Tabitha, posted by Miller on December 19, 2002, at 8:51:48
Do you have medical insurance? If not why don't you get some? If you do I am amazed you can afford this.
Sebastian
Posted by oracle on December 29, 2002, at 21:46:11
In reply to spending a fortune on therapy, posted by Tabitha on December 19, 2002, at 3:03:07
I wonder if it's really helping. My therapist of course says I'm improving, but I feel stuck. Even if I am improving, that's not proof that the therapy is helping. It seems like I'd have to quit to be able to tell whether I need it or not, but then I'd lose my time slot. Plus I'm afraid to quit, because she's my lifeline at this point, the only person who really consistently makes me feel better when I talk to her. I know it feels good, but is it really improving my life to talk about my problems so much?
This bothers me. You should know it is helping, at least I did. I am also hearing alot of dependancy here. You should be building your own support system in therapy. After so many years there really should be no questions that it is helping.
I think you need to bring these issues up to the person you are seeing. Therapy should not go on for years unless 1) there are big issues, like abuse, eating disorders, cronic mental illness
2) you are rich and can afford it.
Posted by Dinah on December 30, 2002, at 19:37:07
In reply to Re: spending a fortune on therapy, posted by oracle on December 29, 2002, at 21:46:11
I have devoted part of two sessions now to this. I go back and forth on it. I know that I have benefitted from having regular twice a week visits. I was probably going twice quite a few weeks anyway, but on a more crisis basis as needed. The added stability seems to have helped me keep my moods more even. And keeping my moods more even has improved my productivity and general functioning.
On the other hand, how can I possibly go twice a week? It seems so self indulgent. Plus it increases my dependence.
Arrrgh!!! Round and round I go again.
Posted by Tabitha on December 30, 2002, at 20:05:28
In reply to Tabitha, have you had any more thoughts on this?, posted by Dinah on December 30, 2002, at 19:37:07
I think I totally understand your dilemma.
For myself I haven't come to any definite conclusion. I might try limiting to 75 minute sessions for a while, and see how that works out.
Posted by Dinah on December 30, 2002, at 21:06:35
In reply to Re: Tabitha, have you had any more thoughts on this? » Dinah, posted by Tabitha on December 30, 2002, at 20:05:28
That sounds like a decent compromise. I could of course try out only going once a week. But an extended period of stability doesn't come that often for me and I hate to screw it up. I guess I'll keep up the current twice a week for a while and see if the stability lasts.
Two months now with no meltdowns!!
Posted by Alii on December 31, 2002, at 0:29:28
In reply to Re: Tabitha, have you had any more thoughts on this? » Tabitha, posted by Dinah on December 30, 2002, at 21:06:35
> That sounds like a decent compromise. I could of course try out only going once a week. But an extended period of stability doesn't come that often for me and I hate to screw it up. I guess I'll keep up the current twice a week for a while and see if the stability lasts.
>
> Two months now with no meltdowns!!That's great Dinah! Two months. Yippee gal. I'm pleased to read that.
~~Alii
Posted by Dinah on January 1, 2003, at 4:57:13
In reply to quick aside to » Dinah, posted by Alii on December 31, 2002, at 0:29:28
And I don't feel that energy building up that might indicate another one is on the way. Of course, they like to surprise me.
Posted by WorryGirl on January 3, 2003, at 14:31:55
In reply to spending a fortune on therapy, posted by Tabitha on December 19, 2002, at 3:03:07
Tabitha,
I understand how you feel about the therapy. Whenever I am seeing a therapist it ends up costing me as much as $800 a month. We don't claim it on my husband's insurance because he's in a high position and doesn't want others knowing our personal business (HR is supposed to be discreet, but it's amazing what leaks out). I can't say that I blame him for not wanting his employees, who are supposed to respect him, to know that his wife is having emotional problems. That would just lead to speculation and I'm already so uncomfortable in social situations, that I don't think I could handle it if everyone knew that my mental state was off.I stopped going to one because the pressure was too intense for me to continue seeing him twice a week. You have to realize that not only was I paying close to $100 for a one-hour session, but I had to pay for childcare, too!
He seemed to think we were making progress. I can honestly say I felt no better after 7 months of his therapy, even though he was very nice and the only person who was willing to listen to me unload (that was worth $100, just not twice a week!).
I've seen two other therapists only once and didn't return because I didn't feel good chemistry with them. Maybe I shouldn't even be worrying about that, but it would be hard for me to open up to someone who I don't even feel likes me.I think you should tell your therapist you are taking a long, much-needed vacation (spend some of that money saved by not going to therapy) and see how you feel after a month or so of no therapy. Another thought is that if you desperately still need some support go to another therapist during this hiatus from your original therapist.
If you don't feel that you have improved after all this time I doubt that this particular therapist is helping you.
Just another thought - if you are not dependent upon your current career, maybe you could try another avenue doing something less stressful and something that you truly enjoy.
I hope things get better for you.
Posted by Tabitha on January 3, 2003, at 15:29:44
In reply to Re: spending a fortune on therapy » Tabitha, posted by WorryGirl on January 3, 2003, at 14:31:55
Thanks WorryGirl. At this point $800/month sounds like a bargain! I've decided to try limiting myself to 75 minute sessions for a while, so maybe I can get back to that price range. I'll see how that goes.
I don't even let myself think about whether my company's HR dept knows about the amount billed to the insurance.
It's truly a vicious cycle, I have the high-stress job that pays for therapy, and the therapy to help manage the high-stress job. I'd love to end the cycle for a while, but I'm just afraid to do it right now with unemployment so high in my field.
I've just had a 2 week vacation, from both the job and the therapy, and I feel perfectly fine. Better than fine actually. I think unemployment and solitude suits me just fine!
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