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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Tabitha on July 27, 2012, at 11:54:54
Just noticed it was only 6/7 when I last posted about terminating. Since then I got diagnosed with breast cancer and had the most intense anxiety of my life. Then had a really good session that made me question terminating. Next session after that was the same old stuff. There was some good, and some stuff that just made me angry and took me some time to shake off. I came to a point of thinking this just isn't right, there shouldn't be this much conflict and so much doubt at this point. Plus I just shouldn't be spending energy and attention on conflict with *anyone* at this point, certainly not paying big bucks for the privelege. Now is the time to take maximum possible care of myself.
Then to my irritation the insurance company paid *her* instead of me what they owed me for this year. It's wrong, I already paid for the sessions so the check should come to me. She left a message saying I now have a credit. This happened before and she said she couldn't just write me a check, there's some tax reason, so she had to return the check and get a new one issued directly from the insurance. I'm so incensed she would just assume I'm OK paying in advance for what works out to about three months worth of sessions. I'm not OK with that at all!
Then we're arguing about how to manage my cancer diagnosis. There's a lot of uncertainty for breast cancer outcome. At first I was giving too much weight to the worst-case possibility and she pointed that out and I did manage to stop assuming the worst. But she wants me to assume the best, picture myself having that best-case outcome and all that. I really don't want to spend energy trying to convince myself something is true when there's no way to know. I want to live well with the uncertainty. That seems truest to me, and strongest.
Then she gave me a very flaky bit of advice. She told me I should stop wearing diamonds because they're bad for cancer. I kid you not, it was something about how the root chakra is already too strong with cancer, and diamonds strengthen the root chakra. I wear a diamond necklace and two rings including my wedding/enagement ring. I've been wearing the necklace 24/7 for 9 years, and the rings slightly less. So it's no small thing to stop wearing these.
For a bit I actually considered this, even though I know it's some totally made-up notion with not a shred of evidence behind it. I had an impulse to stop wearing jewelry early in my treatments, but it passed. Then her bringing this up just resonated enough for me to consider it. OTOH, I really don't want to be a silly superstitious person going through cancer treatment. If there was some personally meaningful thing to wear for comfort I'd do it, but some crackpot theory about diamonds is not personally meaningful.
I was angry I even had the distraction of considering this stupid theory and debating how hurt my husband would be if I stopped wearing the lovely engagement ring he bought me, only a week after our wedding. Does it not sound kind of f'd up to tell me to stop wearing my diamonds when I'm a newlywed, out of fear they'll hurt my cancer treatment?
The other thing I've realized is I'll be spending less money on cancer treatment than on therapy! My medical insurance has an out of pocket max for medical that is much less than my annual out of pocket for therapy. It seems sooo wrong to spend so much on a little bit of coaching and emotional support.
Sorry for yet another rant about my bad fit with my therapist and my anger over the expense. I hope I'm back here in a few weeks saying Well folks I finally terminated.
Posted by Dinah on July 27, 2012, at 17:35:51
In reply to Wanting to terminate, again, posted by Tabitha on July 27, 2012, at 11:54:54
Maybe it is time.
I think that it's possible that there comes a time when you've gotten all you can from a therapist. I'm not sure when that point came for you, if it has come. But it's entirely possible that you're there. And even that you've been there for a good while.
Is it possible to break without making it final? Asking for a refund of your prepayments of course. I suspect it's easier if it isn't a grand event, but merely a fizzle. Can you say you'd like a break for a month or so and see how it goes?
If my therapist ever mentioned anything about my root chakra... Well, I don't think he'd dare.
Not that there's anything wrong with that, for people who find it helpful, of course.
Posted by sleepygirl2 on July 27, 2012, at 20:34:37
In reply to Wanting to terminate, again, posted by Tabitha on July 27, 2012, at 11:54:54
That diamond thing is ridiculous, IMHO.
I had that check thing happen. My Pdoc threw it out accidentally (as he wasn't expecting one- they come to me). I called my insurance company, they called him, a new check was issued to me. That credit thing is ridiculous, unless you agreed to it. She was already paid by you.
Geez....
That'd bother me
Posted by Willful on July 27, 2012, at 22:43:41
In reply to Wanting to terminate, again, posted by Tabitha on July 27, 2012, at 11:54:54
Her keeping the money is just wrong. First of all, it's coercive, since you've talked about terminating, apparently against her wishes. Your decision to terminate is not her call-- keeping the money holds you hostage until the failure to reimburse you is paid off. She ought to know it's not her money.
What's worse, she has no way of knowing that you don't need extra funds now, since you're having medical problems. How does she know what unexpected expenses you might have?
That alone is enough to suggest she's very confused about her role, at the moment.
The advice about the diamond is also so off-base. I would hope she would have some idea of what your beliefs are and respect them. Not to mention that there's no scientific evidence to indicate any role for chakras or whatever in cancer. That makes me wonder what other possibly destructive unscientific advice she might give you.
It might seem relatively harmless whether you wear the rings-- but first of all, they ahve meaning to you-- and your husband-- and taking them off would be a sad thing. But beyond that, she should know that you don't believe in this sort of pseudoscience-- and have the good sense to keep such advice to herself. If you were undertaking fraudulent treatments, etc, it might be her responsibility to speak out-- but since there's not one iota of evidence that she's got a point, and her ideas are not only unwelcome, but wrong-- it seems truly another confusion about boundaries.
As far as ending with her, I dont know. But she needs to give, you the money asap, and look into what could possibly have made her imagine that it was okay for her to essentially manipulate you-- and plan and simple, take what belongs to you.
I don't mean to be harsh, but I am really taken aback by both items--
Posted by Tabitha on July 27, 2012, at 23:28:38
In reply to Re: Wanting to terminate, again, posted by Willful on July 27, 2012, at 22:43:41
Thanks for the perspectives Dinah, Sleepygirl, and Willful. Sometimes I think I hit the point of diminishing returns back around 2000. Seems every time I'm really ready to stop, she'll tell me something new and useful and I get convinced there's a new phase in store.
I didn't think of the chakra/diamond thing as a boundary issue. I used to be somewhat open to intuitive-based beliefs like that, but in the last few years I've really wanted to discard irrational beliefs. Never considered I had a right to have my beliefs respected. I'm sure she uses less of that stuff with me than others, but it still keeps coming up. I assume she truly does believe in it and sees my unwillingness as some kind of resistance that she needs to keep trying to push against.
I did clear up the money issue, just called and said I'm not comfortable and annoyed that she'd assumed it without discussing it. She said of course she'll write me a check. Thanks for validating my anger on that one.
Posted by Phillipa on July 28, 2012, at 10:08:06
In reply to Re: Wanting to terminate, again, posted by Tabitha on July 27, 2012, at 23:28:38
Had to add you don't need anymore stress at this time in your life. And think of the females in the world with a diamond do they all have cancer? Wear your rings and enjoy. And best of luck. Phillipa
Posted by sigismund on July 28, 2012, at 12:46:47
In reply to Re: Wanting to terminate, again, posted by Tabitha on July 27, 2012, at 23:28:38
And what about that positive thinking nonsense?
I am always so annoyed by that (perhaps it feels like mind control?); it just exasperates me.
Why assume the best? Assume the worst, prepare for or against it, and hope for the best, sounds better.
Posted by Willful on July 29, 2012, at 11:41:43
In reply to Re: Wanting to terminate, again, posted by Tabitha on July 27, 2012, at 23:28:38
It's an interesting dilemma, Tabitha, and is an example why it's an issue if a therapist and patient don't share the same core beliefs--or beliefs on an important issue. When someone is has a physical problem and a therapist has a lot of dubious-- or irrational-- ideas-- it's inevitable that she's going to want to help you by telling you what her beliefs would dictate. But if you don't believe in chakras, or astrology, or numerology--or who knows? what-- and she does-- it's going to be a moment of breakdown of what therapy really relies on- which is the therapist's wisdom in living.
She could be dangerous to a patient who was susceptible to her ideas-- which thankfully you aren't. But still, it's going to be a sticky subject-- which at the moment, is really unfortunately a paramount one for you. --This is even more true if she considers it resistance, as opposed to a legitimate belief system which needs to be respected--completely-- and at this point made a priority. How can she help you with your feelings about treatments etc, if she worries that you haven't taken off your diamond ring-- or that you need to fix your root chakra or so forth? How do you feel in not taking off your diamonds-- when she's explicitly told you that could make you sick? That puts you in such a bad position-- feeling somehow that the diamonds are a symbol or cause of something-- and also that wearing them is a direct rejection of her advice. You were even considering taking them off-- even though you didn't want to, and it would hurt your husband. People wear these things because they have a lot of meaning-- and don't take them off easily. It puts you on a bad footing with her-- and for me, would make me uneasy about the diamonds, despite my rational self.
-- if she hasn't been able so far to put aside her ideas-- certainly now she'll feel pressure to "help" you by putting them out there.
It looks like it could be a really troubling issue-- as you need to rely on her to be there 100% for you in this challenging situation-- .
I have to tell you too that although the money situation is resolved, it seems enough of a violation to me to be a continuing problem that she could handle the money that way unilaterally. Where is the respect? Where is the sense of boundaries? How does she see you that she could even begin to take the money? Particularly as you've been talking about ending?
If you were getting a great deal from her-- of course-- all of that could be handled- although I guess I wonder where her pseudoscience ends and her commitment to science begins-- but if you're at odds with her-- or doubting the value of your work-- I guess I would see these as long=term and very troublesome indications of a bad fit. Which may be the last thing you need now.
On the other hand, breaking off a supporting and very long relationship may also not be a good thing-- but it is a dilemma that I'm sorry you're in-- given how difficult things are now.
As I write, I wonder how are things going on the medical front? Are you feeling ok? is your energy and are your spirits rebounding?
all the best-- Willful
Posted by Willful on July 29, 2012, at 11:50:32
In reply to Re: Wanting to terminate, again, posted by sigismund on July 28, 2012, at 12:46:47
I always want to ask these panglosses--Is it okay if I assume the unknown, prepare, for a limited amount of time, for the worst--with the proviso that it probably won't happen-- and spend my energy remembering that the best, or at least the good, is also within reach-?
its important not to foreclose the best, or the good-- but assuming it? that seems to raise the issue of the worst, really-- a reasonable belief, not a panglossian belief gives me the most strength.
We should all carry around a copies of Voltaire to distribute to these starry-eyed well wishers. I wonder if they are so staunch believers in the best when they're under some difficulty?
Posted by Tabitha on July 29, 2012, at 12:19:28
In reply to Re: Wanting to terminate, again » Tabitha, posted by Phillipa on July 28, 2012, at 10:08:06
Right Phillipa, it's silly to think about, since so many women do wear at least one diamond.
> Had to add you don't need anymore stress at this time in your life. And think of the females in the world with a diamond do they all have cancer? Wear your rings and enjoy. And best of luck. Phillipa
Posted by Tabitha on July 29, 2012, at 12:28:27
In reply to Re: Wanting to terminate, again, posted by sigismund on July 28, 2012, at 12:46:47
You know sig, I'm annoyed by positive thinking too, but I did have to adjust my attitude for the better. I wouldn't say I assumed the worst, but I definitely did a lot of worrying about the worst. Now if I spent a lot of time dwelling on the worst, I'd be a wreck, because the worst is just too awful. I need to try not to assume best or worst case, and stay in the here and now, and remember I *do* have a good chance of a good outcome as well.
> And what about that positive thinking nonsense?
> I am always so annoyed by that (perhaps it feels like mind control?); it just exasperates me.
> Why assume the best? Assume the worst, prepare for or against it, and hope for the best, sounds better.
Posted by Tabitha on July 29, 2012, at 12:37:48
In reply to Re: Wanting to terminate, again, posted by Willful on July 29, 2012, at 11:41:43
Thank you for your thoughtful comments, Willful. I think you've hit on a lot of important points. I have been questioning the value of a lot of the advice for years, and spending time (and money) arguing against it. I learned a lot from the relationship, but I've always had to filter out some of the not-so-helpful guidance. Which leads me to wonder if this is typical for therapy, or if I had a less than optimal fit. But obviously I've been reluctant to break it off. Mostly out of fear that without her, I'd start burdening others around me with my problems and worries.
I have never read Voltaire. I may just add that to my reading list. I don't always do so well with old fashioned language, but I did enjoy Flaubert.
Posted by Phillipa on July 29, 2012, at 21:42:05
In reply to Re: Wanting to terminate, again » Willful, posted by Tabitha on July 29, 2012, at 12:37:48
Have you joined a support network with others with same problem? There would I'd think also be therapists that could be a good fit. Phillipa
Posted by Dinah on July 30, 2012, at 11:14:27
In reply to Re: Wanting to terminate, again » Willful, posted by Tabitha on July 29, 2012, at 12:37:48
> But obviously I've been reluctant to break it off. Mostly out of fear that without her, I'd start burdening others around me with my problems and worries.
Boy, do I identify with this. That's why I suggested a break instead of a Termination with a capital T. Once you're away from the situation, you can better assess whether *not* having her in your life is causing a problem, or if you've developed enough of a support network and internal strength to manage without her. When you're in the middle of it, fear about the future can cloud the decision making process. If you find you are using your friends and family as a therapist, and you need that in your life, you can return to her or to someone new. If you find you manage quite well without her, you can agree not to schedule any future appointments unless needed - or maybe see her for a few sessions to review your progress.
I do understand that fear. I think if my parents had had a therapist, I'd have been a lot better off and their relationship would have been better off.
Would she let you have a month off?
I think it potentially could be a positive experience, and that you could think of her as helping you to the point where you don't really need her anymore. That the relationship may already have met the original goals.
Do you feel the need to call her between sessions when things are really bad? I find that very telling with my therapist. Calling his is no longer something that occurs to me, or if it does, I shrug and ask myself what he could do anyway. Then take a Risperdal.
Posted by Dinah on July 30, 2012, at 11:16:08
In reply to Re: Wanting to terminate, again » Tabitha, posted by Dinah on July 30, 2012, at 11:14:27
I think a break would be useful even if you do decide to return. You'd be able to return with a new understanding of what therapy does do for you, instead of constantly feeling like you're straining to get away.
Posted by Tabitha on July 30, 2012, at 23:48:30
In reply to Re: Wanting to terminate, again » Tabitha, posted by Phillipa on July 29, 2012, at 21:42:05
> Have you joined a support network with others with same problem? There would I'd think also be therapists that could be a good fit. Phillipa
I haven't yet had time to join a support group. There is a social worker at the cancer center and I've considered trying a session with him. I'm curious what someone who specializes in counseling cancer patients would be able to do for me.
Posted by Tabitha on July 30, 2012, at 23:57:51
In reply to Re: Wanting to terminate, again, posted by Dinah on July 30, 2012, at 11:16:08
> I think a break would be useful even if you do decide to return. You'd be able to return with a new understanding of what therapy does do for you, instead of constantly feeling like you're straining to get away.
Yes, it's such a sensible idea. I don't know why she has been so resistant to it. Seems like I'll have to insist.
Posted by Tabitha on July 31, 2012, at 1:17:09
In reply to Re: Wanting to terminate, again » Tabitha, posted by Dinah on July 30, 2012, at 11:14:27
Apologies if I end up double-posting, but I replied to this and it got lost. Trying again...
> Would she let you have a month off?I had the idea to taper off with larger and larger intervals between appointments. Her idea was quite different-- she said termination was usually at least three months of weekly sessions. I can't imaging spending 12 sessions on termination.
>
> Do you feel the need to call her between sessions when things are really bad? I find that very telling with my therapist. Calling his is no longer something that occurs to me, or if it does, I shrug and ask myself what he could do anyway. Then take a Risperdal.Dinah I've noticed the same thing and I do find it telling. After my diagnosis, which is the hardest thing that's hit me in years, I didn't have the urge to call her. I called a friend and then over the weekend called a nurse line to get a short-term ativan Rx. In the subsequent weeks I had the same thinking when I was in distress-- I knew she couldn't do much if anything for me, so it was better to wait it out, distract myself, or take half a xanax. Now I'm barely using the xanax and still having no desire to call her.
Posted by Dinah on July 31, 2012, at 8:39:47
In reply to Re: Wanting to terminate, again » Dinah, posted by Tabitha on July 31, 2012, at 1:17:09
> I had the idea to taper off with larger and larger intervals between appointments. Her idea was quite different-- she said termination was usually at least three months of weekly sessions. I can't imaging spending 12 sessions on termination.
I think it's wrong of her to pressure you into this. My therapist was pretty good about letting me leave if I needed to leave. About a year ago, I took a month off of therapy due to some issues I was having with him. I did realize in that month off that while I wasn't as dependent on him as I once was, I still did need therapy in my life.
> Dinah I've noticed the same thing and I do find it telling. After my diagnosis, which is the hardest thing that's hit me in years, I didn't have the urge to call her. I called a friend and then over the weekend called a nurse line to get a short-term ativan Rx. In the subsequent weeks I had the same thinking when I was in distress-- I knew she couldn't do much if anything for me, so it was better to wait it out, distract myself, or take half a xanax. Now I'm barely using the xanax and still having no desire to call her.
>I think you should trust your feelings. Maybe standing up for yourself and your own preferences is the final exam of therapy. Or maybe it's just the midterms. There's no reason to be confrontational about it. Just firm. As I'm sure she probably has taught you to be with others.
Remember the broken record technique. You can tell her that this is what you need at this time, whatever the future holds for therapy, without being angry or confrontational.
I don't think resentment and a desire to leave is the best setting for therapy - or even for a "good" termination. It surprises me that she doesn't understand this. And that she doesn't understand if someone in a relationship is ambivalent, trying to hold onto them with pressure is the best way to guarantee a bad ending.
Posted by Tabitha on July 31, 2012, at 11:41:54
In reply to Re: Wanting to terminate, again » Tabitha, posted by Dinah on July 31, 2012, at 8:39:47
> Remember the broken record technique. You can tell her that this is what you need at this time, whatever the future holds for therapy, without being angry or confrontational.Dinah that's a good way of putting it. "This is just what I need right now." I've been rehearsing a big argument about the reasons I don't think it's a good fit, but we've had that argument before and she doesn't seem to really get my points. She partly gets them, then adds something that makes it seem like it's some lack on my part, then I start to doubt myself.
I suspect she is conflicted about it herself. She has acknowledged that my wanting to leave is a healthy impulse, then she's also made comments like "well if you need to quit therapy to feel good about yourself..." Sheesh!
My next session is Wednesday. I want to get out of there with the refund check and no future appointments.
Posted by Willful on July 31, 2012, at 15:13:49
In reply to Re: Wanting to terminate, again » Dinah, posted by Tabitha on July 31, 2012, at 11:41:54
This isn't a case of an impulsive gesture, or a need to make a "statement" about anything. It seems as if this is the result of a long-standing evolution of thought and feeling, and as if you've given the relationship many chances, much time and energy, to prove itself necessary.
Nothing is black and white: there's no point at which you're getting nothing from a relationship, at which it's completely clear, with no possible second-guessing, and no possible alternate case for staying. There will always be those things-- but it's really the consideration and thoughtfulness that you've given the question-- and the extent to which this sense has struck with you that should guide your actions, I think.
Your judgment doesn't seem swayed by the feeling of a moment-- or by a reaction to what she does, per se-- that is, you're not acting from resistance, or defiance, or fear. There are reasons not to end therapy. despite the desire to. But there are reasons that justify ending it. I'm not hearing warning signs that this is self-defeating, or nihilistic.And even if it were-- you'll come to see that in the break. And that, too, will give you information.
If I reached the point that you have, I would follow my judgment and hold to my own perceptions. Of course, she has some points-- and maybe she sees things that need work. Perhaps you'll decide on a new therapy. But you deserve to make judgments and follow them-- to go with your own point of view, not hers.
This can be a provisonal break--a time to review and reevaluate, with the expectation that it may last, but that it may lead to some period of fewer sessions, etc.
But this is your life and your therapy-- not hers. If you're afraid of not seeing her-- try it out-- and if it isn't what you need, then you can find another therapist, or return to her-- with renewed commitment and purpose.
Posted by Dinah on July 31, 2012, at 16:53:42
In reply to Re: Wanting to terminate, again » Dinah, posted by Tabitha on July 31, 2012, at 11:41:54
I think that if you try to convince her you have a point, it maintains engagement. And is rather unlikely to succeed.
One of my therapist's major strengths is his tendency to eventually acknowledge that he might be wrong. But I'm not sure your therapist has that particular strength, and even if she does, you might not want to invest that amount of time.
On the other hand, this being something you need to do right now is not really open to argument. (Which doesn't mean she won't give it a shot, of course.)
Does it matter that she agree with your feelings about therapy? It would be nice, of course, but is it worth a big investment?
Posted by Phillipa on July 31, 2012, at 20:39:30
In reply to Re: Wanting to terminate, again » Phillipa, posted by Tabitha on July 30, 2012, at 23:48:30
Tabitha personally I think this would be a great idea. Others with the same problem see this social worker so lots of experience with the medical issues you are dealing with now are a priority to me. Can you kind put the other older issues on the back burner for Now? Concentrate on one thing which is support for your condition. Don't divide yourself you need all your energy now on the same topic. Phillipa
Posted by Willful on August 1, 2012, at 9:54:58
In reply to Re: Wanting to terminate, again » Dinah, posted by Tabitha on July 31, 2012, at 11:41:54
Good wishes for your appointment today.
Willful
Posted by Tabitha on August 1, 2012, at 23:35:26
In reply to Re: Wanting to terminate, again, posted by Willful on August 1, 2012, at 9:54:58
Well I told her up front I didn't want to have another appointment. Got my check, returned her energy healing meditation CD, told her I was miffed about the diamond thing, then we just did a typical session of catching up, spent time on my hair (which fell out this past weekend). Then it was near the end, she said I should come back in two weeks and we'd talk about terminating then. I said no, she countered with OK we'll do a termination session then, I asked who's that for, you or me? Said I did not want another appointment, she said OK then let's do it now. Said no, it was already too late and I have things to do (I have a chemo infusion tomorrow). She said don't you think it's odd to just end like this? I agreed it was odd but said it's what I need to do. She asked me to agree to call her if I get more depressed. I said I'd call her if I felt like a session would help, whether I was depressed or not. She finally got me to agree to think about calling in two weeks.
Somehow this concept of taking a hiatus just isn't going over with her. It has to be some kind of formal "termination" or not.
At one point in the session I pointed out I've been seeing her longer than I lived with my parents!
So I got what I wanted, which was getting out with no future appointment. Somehow I think she'll surely call in two weeks whether I call or not.
The thought of some kind of wrap up session is really exhausting. I'd think I'd rather postpone that indefinitely.
She said I look adorable in my hat. I feel really self-conscious about it and think I look awful, and that comment really did make me feel batter.
Thanks for all the support here, you all really helped with this.
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