Psycho-Babble Psychology Thread 256618

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Re: Fees and meaning

Posted by Dinah on September 4, 2003, at 4:18:56

In reply to Fees and meaning, posted by Dinah on September 3, 2003, at 10:28:46

When I signed with him over eight years ago, the fee was on a sliding scale and I was at the top of the scale. Then a few years later, worrying about it, I asked him if the fee had gone up, and told him I wanted to pay whatever the current fee was. He named a price which did startle me a bit, but I figured the yearly increase and thought it was in the believable range.

Then I started coming into contact with other therapists, some of whom were psychologists, who I would assume would charge more. And at a rocky patch, I called for appointments elsewhere. The psychologist he referred me to for personality testing looked stunned when I told innocently mentioned my hourly fee. Granted, any psychologist who clearly looked so stunned hadn't been in practice long. Another psychologist was $15 less. The MSW was $20 less. When it started to bug me, I looked up average rates and websites of local therapists. Except for one neuropsychologist, all were at least $15 less.

Now here's where my chronic feelings of shame come in. I am fully aware that during our therapy, and perhaps at the point I asked, my therapist has been "frustrated" with me and my rate of progress, and my personal characteristics. While I don't think he's "frustrated" any more (nearly as much anyway), I just sort of assumed that it cost more to see him because I was so "frustrating". More frustrating than the average client. And that's just been part of my belief for the couple of years I've been aware that he's rather high. Something that seemed so self evident that it didn't even bother me until lately. Why did it bother me lately? I don't know.

But as with many things, maybe it says more about my feelings about myself than it does about him. Maybe the top fee was just set high at his clinic, and you were expected to bargain down. I never was so good at bargaining. I do it once every seven to ten years when I get a car. And even then, I just follow the instructions. I did hope he'd give me at least a small discount when I went from one to two times a week. I'm always afraid he'll raise his rates, and I won't be able to go. When I mentioned my change in financial circumstances lately, he suggested going from twice a week to once a week, but didn't discuss rather I still fit the top of the sliding scale. It's a lot of things.

And it's difficult to mention because money is harder to discuss than sex. And because I am pretty sure he wouldn't say that yes, he's got a $10 annoyance charge on my rate, so what's the point in asking anyway. I don't know that I'll even believe his answer, since the idea is pretty ingrained that I'm unbelievably annoying.

Oh well. I suppose it's a good thing to have in the open, and so I did ask him. To his answering machine because I would never have the courage to ask him in person. And he answered about what I said above. That I was the one who insisted on paying the new rate, that I didn't get charged any more than any private pay client.

It does seem hard to believe, since he must have trouble booking new clients when he's obviously more than the standard rate in the area. But maybe he just thinks highly of his own work and isn't willing to work for less. Or maybe his standard sliding scale includes wiggle room for annoying clients. :) I'm a hard one to convince.

 

Re: Fees and meaning

Posted by Dinah on September 4, 2003, at 4:30:36

In reply to Re: Fees and meaning, posted by Dinah on September 4, 2003, at 4:18:56

I'm sure it's just my feelings of inferiority coupled with my imagination. Forget I said anything.

 

Re: Fees and meaning

Posted by Rigby on September 4, 2003, at 11:15:31

In reply to Re: Fees and meaning, posted by Dinah on September 4, 2003, at 4:18:56

Hi Dinah,

I guess it's a lesson: you don't wanna say that you want to pay top of the new scale till you know what the top is. Ugh. The question though is his new top of the scale an objective or subjective one. I think it's *totally* legitimate for you to feel concerned about this. From both a financial standpoint (sounds like he's off the market) and from a therapeutic standpoint (if he's punishing you in a sense by charging more than that's not cool at all.) I think it's hard to remember with emotions running as high as they do in therapy that, in the end, this *is* a business for therapists. And some therapists aren't necessarily great business people--they might think they can ask for higher prices--as high as the market will bear not knowing that it could come back to bite them. Giving your therapist benefit of the doubt he simply may just charge more as he has higher expenses. You're right though--if he does this to all of his clients he's not apt to bring many new people on.

FYI, my therapist charged me $85/session. I negotiated *down* to $60. Are you comfortable saying what you're paying? It may help us here in terms of getting a perspective.

Also, what helped me was I truly was willing to walk--and you *have* to be to get the price you want. I was very clear about what I wanted--I didn't want to go less than once/week and I would not spend any more than $60. She agreed nearly instantly. Hey, $60/week is better than nothing, right?

Let us know what he says, okay? And again, you're *not* being neurotic about this--it's the real deal--don't shy away from trying to get clear about what you're paying vs. where the market is at--it's about taking care of yourself!!!

Rigby

 

Re: Fees and meaning

Posted by kara lynne on September 4, 2003, at 11:51:31

In reply to Re: Fees and meaning, posted by Dinah on September 4, 2003, at 4:30:36

-$10 annoyance charge-

Dinah that is too precious, although it still breaks my heart because I know somewhere you believe it. I can only relate too well.

Since you were the one that asked about raising the fee can you ask about lowering it? I know you would never, but still...

 

Re: Fees and meaning Rigby

Posted by Dinah on September 4, 2003, at 12:27:43

In reply to Re: Fees and meaning, posted by Rigby on September 4, 2003, at 11:15:31

I'm paying $110 in an area where the cost of living is very low. I see that psychologists, including one I consulted are charging $95. And mine is a licensed professional counselor, which rightly or wrongly is not as prestigious a specialty. The neuropsychologist advertised a rate of $150 I think. My therapist has been doing this for some time, probably fifteen or twenty years.

The thing is that he's good at what he does (usually), and I don't want to walk and he knows it. I just sort of wonder how many clients he actually gets $110 from when they can walk down the street and get $95 or less. No, that's not what I really wonder. I really wonder down deep in my heart if it's just me. He says it's not, but then again, would he admit it was? :) Maybe it's one of those questions I don't want answered.

 

Re: Fees and meaning kara lynne

Posted by Dinah on September 4, 2003, at 12:32:18

In reply to Re: Fees and meaning, posted by kara lynne on September 4, 2003, at 11:51:31

I do believe it deep down. And because I believe it I'd never ask for a price reduction. Because I'd be afraid he'd find reasons to get rid of me. Because I'm afraid I'm not worth taking on at a lower rate.

To be fair to him, he does take calls between sessions and only charges for them if they are extremely lengthy, at least ten minutes. He used to "catch up time" with me. Start late but finish on time. But I called him on that and he doesn't do it any more (at least not very often, maybe sometimes he gets confused). In fact that was the reason I inquired about raising the rates. I noticed my sessions were getting to be more 45 or even 40 minutes rather than 50, and I wondered aloud if that was in lieu of a rate increase. (See. I can be an annoying client. Grin.)

 

Re: Fees and meaning Dinah

Posted by Adia on September 4, 2003, at 12:49:53

In reply to Re: Fees and meaning kara lynne, posted by Dinah on September 4, 2003, at 12:32:18

Hi Dinah,
I am really sorry that you feel deep down inside your heart that he's charging you more just because it's you..and that you feel you're not worth taking on at a lower rate. I can identify with your feelings. My therapist has been really frustrated with my progress in the past and she has told me and we've been through some hard times. Sometimes I am so hard on myself that a part of me just feels grateful that she agrees to see me and lets me be there with her for a while, and I don't feel I can ask anything from her, because I feel she's making such an extra effort to stand me. But these are just my fears...
I feel you are being really hard on yourself..Why would he charge you more than any other clients..? Therapy is hard sometimes but that doesn't mean he will judge you as a person or think bad of you or anything.
I am really sorry you feel that in your heart.
Maybe you can share more about this with him, in writing if you feel it is too hard to talk about face to face..? When I have to talk about money and fees I do it in writing cause I feel so scared that if we do talk about it , she might change her mind and find a reason to leave me.
My therapist usually charges 100$ to her clients, but she changes that according to the finantial situation of each particular client..I pay her $50..and she waits if I can't pay her...she says that we can always work something out.
Maybe you can at least share with him what you feel, without mentioning the money at this point?
How you're afraid of him not wanting to work with you..
and maybe then you can try to share that you are having finantial difficulties..?

I am sending you lots of support,
Adia.


> I do believe it deep down. And because I believe it I'd never ask for a price reduction. Because I'd be afraid he'd find reasons to get rid of me. Because I'm afraid I'm not worth taking on at a lower rate.
>
> To be fair to him, he does take calls between sessions and only charges for them if they are extremely lengthy, at least ten minutes. He used to "catch up time" with me. Start late but finish on time. But I called him on that and he doesn't do it any more (at least not very often, maybe sometimes he gets confused). In fact that was the reason I inquired about raising the rates. I noticed my sessions were getting to be more 45 or even 40 minutes rather than 50, and I wondered aloud if that was in lieu of a rate increase. (See. I can be an annoying client. Grin.)

 

Re: Fees and meaning Adia

Posted by Dinah on September 4, 2003, at 12:58:45

In reply to Re: Fees and meaning Dinah, posted by Adia on September 4, 2003, at 12:49:53

He gets sort of exasperated when I share my feelings that I'm an annoyance to him. But I feel much as you do. I'm just grateful he's willing to put up with me. I seem to progress at a snail's pace, and moreover, I think I see more progress than he does. Last time he was so frustrated that he asked if I thought he was lying to me about my not being a nuisance, if I didn't trust him.

I answered that it said more of what I thought of myself than what I thought of him.

I wonder if in some ways it gives me a greater feeling of security to feel like I'm paying a bit too much, even while I feel hurt about it. Like I'm making it up to him in a way so he won't be as likely to terminate me for my stubbornness.

It's a hard belief to shake. That belief that I am a burden to him. I really really do think that the majority of people he works with are less difficult than I am. That he primarily does short term CBT work with anxiety and depression and doesn't have the transference stuff that I bring to the therapeutic relationship. It's not that he's bad at it. He's really pretty good with it now. I just get the idea that it's not what happens with the majority of his clientele.

 

Re: Fees and meaning Dinah

Posted by Penny on September 4, 2003, at 13:06:59

In reply to Re: Fees and meaning Rigby, posted by Dinah on September 4, 2003, at 12:27:43

Oh Dinah.

I do hope that one day you can see yourself for who you really are - a caring, warm-hearted and thoughtful person.

My psychologist's standard fee is $120 for a 45 minute session, but my MSW therapist in Charlotte charged $95 for a 50 minute session, then allowed me to pay her $60 a session after my insurance ran out.

My current therapist is allowing me to pay her less than what I am supposed to be paying her ($15 copay plus 20% of the fee insurance pays her - $111), but it's not a reduced rate - I owe her what I'm not currently paying her, to be paid, as she put it, when I can.

My feeling about you and your therapist is this: if he REALLY didn't care about you or REALLY didn't like you or REALLY thought you were a great deal of trouble, then he would fire you as a patient. But he hasn't done that. Perhaps he does see you as challenging (though I suspect that you perceive yourself to be more of a challenge than he does), but maybe he likes a challenge.

Try to be a bit easier on yourself, dear Dinah. Taking what you say about yourself as the truth, one would think you were a terrible person - but we on this board know that is NOT THE TRUTH. We know you as you are - your kindness comes across clearly. Your vision of yourself is skewed, as is mine of myself (so you tell me), and as is the vision of many people on this board of themselves. So listen to me and to others when we tell you that you ARE NOT the 'bad' person you think you are.

(((Dinah)))

P

 

Re: One more thing... Dinah

Posted by Penny on September 4, 2003, at 13:08:37

In reply to Re: Fees and meaning Rigby, posted by Dinah on September 4, 2003, at 12:27:43

How very brave of you to bring it up with him, even if via voice mail! That was a gutsy thing to do - discussing money issues with therapists in particular is just plain difficult - but you did ask, even if the response wasn't as thorough as perhaps you'd like it to be.

P

 

Re: Fees and meaning Dinah

Posted by judy1 on September 4, 2003, at 13:12:04

In reply to Re: Fees and meaning Adia, posted by Dinah on September 4, 2003, at 12:58:45

Dinah,
I have had a HUGE variation in the amounts paid to different psychs- from a $15 co-pay for my therapist to an in- network psychologist who also charged the co-pay but would bill me $20 for every inter-session phone call (lasting an average of 15 minutes) to my out of network (and fairly famous) psychiatrist who charges $200/ hour with unlimited phone calls and e-mails that are all promptly answered. Quite frankly the psychologist who charged extra for phone calls annoyed me for that reason (even though he was helpful) and I dropped him. I have never negotiated fees, but I never negotiate anything (even cars). If your therp told you he charges what he charges all his clients, then I would believe him. I think you're feeling insecure right now and maybe that's really what the issue is- not the actual money. What do you think?
take care, judy

 

Re: Fees and meaning

Posted by sadmom on September 4, 2003, at 14:02:51

In reply to Re: Fees and meaning Dinah, posted by judy1 on September 4, 2003, at 13:12:04

I've had two instances in the past year where I thought I was treated unfairly. One I was right about, and the other one I was wrong. Last December, my children's psychiatrist jacked-up his bill. I thought he was doing it because he thought my children weren't worth the work and he wanted us to go elsewhere. I was really upset and went crying to my therapist. A month later I was at the reception desk, scheduling another appt while someone else was checking out and paying their bill. I glanced at their invoice and noticed their charge was higher also.
That is one way you could find out what other people are being charged.

The other problem I had was with a church daycare.
They had a sign out saying they had openings. When I went inside to inquire, they said there weren't any openings. I had brought my son who doesn't have a hand inside. I then had my sister call the church daycare and act like she was a parent with a son the same age as my son. Over the phone, they told her they had openings. I was upset, but I felt I didn't have time to file a complaint or whatever. I also decided if they acted like that, I didn't want my son there.

For your peace of mind, I do think you have to find out if you are being charged a fair fee. If you aren't, then you want to find a more suitable therapist. If you are being charged the same fee as others, then you can stop worrying about it.

 

Re: Fees and meaning

Posted by kara lynne on September 4, 2003, at 14:05:21

In reply to Re: Fees and meaning kara lynne, posted by Dinah on September 4, 2003, at 12:32:18

Well I must be equally annoying then. I would certainly have asked about the sessions waning down to 40 minutes--and--I probably would have gone exactly where you did with it.

Not that that's a good thing, but just so you know you're not alone...

 

Re: Thanks Penny

Posted by Dinah on September 4, 2003, at 16:08:29

In reply to Re: One more thing... Dinah, posted by Penny on September 4, 2003, at 13:08:37

It was hard. I've known about his rate being high for years, and never had the nerve to bring it up.

If he brings it up again Friday, I guess we'll discuss it more. But I suspect it's likely he won't. :) I'm sure talking money is as hard for them as it is for us. Besides, he's leaving town *again* on business next week and I'm feeling a bit insecure about that so I'm unlikely to bring it up. I had one of my very unsubtle dreams where I was a little girl and my mother informed me she was only going to take care of me (cook dinner, bring me to school) every other day and the other days I was on my own. I tell you my dreams are sledgehammers. :)

(And I'm way more annoying with him than anything the board has ever seen from me. lol)

 

Re: Fees and meaning judy1

Posted by Dinah on September 4, 2003, at 16:14:40

In reply to Re: Fees and meaning Dinah, posted by judy1 on September 4, 2003, at 13:12:04

I'm sure that's true, Judy. I guess I have no real choice but to trust him. And it's certainly not that I don't think he's worth it. For the most part, I haven't liked the mental health professionals I've come in contact with. If it's true (as I have no choice but to trust it is) that he isn't charging more to me than to others, or if my charge is based on my poor bargaining skills, I'm not upset about it. It was if the charge was an assessment of me rather than of him that I had a problem.

By the way, my not so famous psychiatrist is $80 for a fifteen minute med check that rarely goes over 5-10 minutes. But his fee increases are written on poster board in his waiting room, so my feelings of inferiority aren't activated. :)

 

Re: Fees and meaning sadmom

Posted by Dinah on September 4, 2003, at 16:18:39

In reply to Re: Fees and meaning, posted by sadmom on September 4, 2003, at 14:02:51

Thanks Sadmom. That must have been difficult for you. If I thought anyone was doing that to my son, I'd be wild with fury. Me is one thing, but my kid? No.

I'm glad you found out that the psychiatrist at least wasn't doing that. And I'm sorry about the daycare. It doesn't sound like a very spiritual thing to do. And I'm sure he is better off elsewhere.

I have no real way of telling fees for others. He collects the fees himself before we leave the therapy room. I have to take his word for it. But I am glad I brought it up. (Unless he gets mad about it. Then I'll be upset.)

 

Re: Fees and meaning kara lynne

Posted by Dinah on September 4, 2003, at 16:20:07

In reply to Re: Fees and meaning, posted by kara lynne on September 4, 2003, at 14:05:21

LOL. I'm glad I'm not alone.

And I'm glad I've gotten the big money monster out of the closet. At least I've brought it up with him.

 

Re: Fees and meaning Dinah

Posted by fallsfall on September 4, 2003, at 22:17:17

In reply to Re: Fees and meaning kara lynne, posted by Dinah on September 4, 2003, at 16:20:07

Dinah,

All of the posters are right that you are a wonderful person and shouldn't feel that you are a burden on your therapist.

You said: "I just sort of assumed that it cost more to see him because I was so "frustrating"." I recall a post back in the Forever Therapy days (and I'll find it for you if I need to) where you said that he had said that you were his oldest client and that you could stay as long as you wanted? Well, at least the oldest client part if for sure. The point is that he was saying that you are special to him. I would give anything to have a therapist tell me that. You are special to him. He wanted you to be his patient. I think that his annoyance that you keep bringing up that you are a burden is because he keeps telling you that you are NOT, but you never hear him.

Why would he lie to you about this when he doesn't lie to you about anything else?

If he wasn't going away next week (the rat) I would suggest that YOU bring it up and duke it out.

You can't let these things fester. The therapy relationship is too important. The problem you are having with him (thinking that you are a burden) is a problem that you have elsewhere in your life. This is your chance to work on it.

(((((((((((((((Dinah))))))))))))))))))

P.S. My old therapist was $105 (PhD). My new therapist is $150 (PhD) - reduced to 135 for a couple of months. My old group therapist is $100. I went with the new guy instead of her because I thought he would do a better job. People will pay more if they think that they are getting more.

 

Re: Fees and meaning fallsfall

Posted by Dinah on September 5, 2003, at 0:21:32

In reply to Re: Fees and meaning Dinah, posted by fallsfall on September 4, 2003, at 22:17:17

Hmmm. When you wrote that I started thinking in the back of my mind. I don't think it's a global sort of neurosis at work here. I think the problem is that I am at my neediest with him. Openly needy. And somewhere along the road, I must have learned that being that needy was completely unacceptable. So maybe it isn't that I think I'm an annoying client in general, maybe it's just that I think my neediness is necessarily repulsive to him.

And just maybe, I'm picking up some hints from him that he does find my neediness a bit much. Or maybe that's coming from me. But in either case, it's possible that he finds that one part of me unappealing even if he doesn't find all of me annoying.

Or maybe I'm sleep deprived again and spouting nonsense.

P.S. I do think I'm getting more, and I am willing to pay more for it. :)

 

Re: Fees and meaning Dinah

Posted by Penny on September 5, 2003, at 7:51:51

In reply to Re: Fees and meaning fallsfall, posted by Dinah on September 5, 2003, at 0:21:32

> And just maybe, I'm picking up some hints from him that he does find my neediness a bit much. Or maybe that's coming from me. But in either case, it's possible that he finds that one part of me unappealing even if he doesn't find all of me annoying.


How many people do you know that you like completely and totally one hundred percent??? I mean, really. There is ALWAYS something about someone you probably don't like. People are not perfect - and that's okay! It's okay to not like someone completely and totally one hundred percent! That doesn't mean that you don't like them more often than not. And it certainly doesn't mean you don't care - even when there are things about someone you don't like, often you still care.

My point? IMO, you are looking for evidence that he is annoyed by your neediness. First of all, it's perfectly okay that you are more needy with him than with anyone else in your life. As you've said, your needs weren't met growing up (which I'm sure most of us can relate to!), so you're trying to get them met now. And that's okay - that's what he's there for! To in part meet those needs and in part help you try to meet those needs for yourself.

Yes - it's possible that he finds part of you unappealing - just as you find part of him unappealing - but please don't let that make you feel like you are a burden on him. You are someone he has chosen to keep working with. You are someone who is worth every bit of the time he spends with you and then some. This doesn't have to be black-or-white. And it seems, from what you have described, that his reactions to your questions and actions have shown this - that it is all about shades of gray.

As you know, some days we can take more from people than others. Perhaps some days he finds you more exasperating, but that doesn't mean that other days he doesn't, and it certainly doesn't mean that he's ready to give up on you.

I also agree with fallsfall. I think that perhaps part of what you're sensing is the frustration he shows as a result of you not accepting that he isn't overwhelmed by your neediness.

Neediness is not a bad thing. Especially when it comes to therapists. And I think his belief in you is strongly evidenced by the length of time you've been his patient. At this point you have to accept that he cares a great deal about you - because, honestly Dinah, if not, do you really think he would have treated you for this long?

((((Dinah))))

I truly hope that one day you can go easier on yourself. As I said before, and as others have said, you are a wonderful person, and you deserve all the good things in the world.

P

 

Re: Fees and meaning Dinah

Posted by fallsfall on September 5, 2003, at 8:18:25

In reply to Re: Fees and meaning fallsfall, posted by Dinah on September 5, 2003, at 0:21:32

Penny wrote: How many people do you know that you like completely and totally one hundred percent??? I mean, really. There is ALWAYS something about someone you probably don't like. People are not perfect - and that's okay!

Gee, Dinah, that sounds an awful lot like what you were saying to me last night.

The other place in your life where I have seen this pattern is with your husband. You have felt that you are too much of a burden on him and that he would be better of without you.

I'm sure glad that you are here.

Also, don't you sometimes (not all the time) find neediness appealing - it gives you a chance to help someone else. It isn't always bad.

 

Re: My session

Posted by Dinah on September 5, 2003, at 16:39:06

In reply to Re: Fees and meaning Dinah, posted by fallsfall on September 5, 2003, at 8:18:25

My therapist said he wasn't angry at my bringing it out. He said it was something I had every right to ask about. And he reiterated that his charge wasn't based on how annoying his client was. :)

But the funny side effect was that fees also came up in other part of the discussion we had today. As if by mentioning it, I had removed the taboo from the subject. Now it can be a natural part of any discussion of the therapeutic relationship. Isn't that odd?

And yes, I do understand all that about being annoying in some ways but not in others. But this one thing is so deeply ingrained in me that, as my therapist said today, only I can convince myself that it isn't true. And we're going to work on that over time, since it isn't quickly done.

 

Re: My session Dinah

Posted by fallsfall on September 5, 2003, at 16:52:29

In reply to Re: My session, posted by Dinah on September 5, 2003, at 16:39:06

It sounds like the discussion went well. I'm really glad. I'm also glad that the two of you will work on your view of how annoying you are. That sounds like a good plan.

 

Re: My session

Posted by Rigby on September 5, 2003, at 18:33:04

In reply to Re: My session, posted by Dinah on September 5, 2003, at 16:39:06

Hi Dinah,

I'm so glad this worked out!! I'm also really glad you decided to ask and get it worked out. Yes!!!

Rigby

 

Re: My session Dinah

Posted by Penny on September 5, 2003, at 21:05:49

In reply to Re: My session, posted by Dinah on September 5, 2003, at 16:39:06

I'm so glad you discussed this with him! What a relief for you, it sounds like.

I'm proud of you for facing that fear head-on. I know it was a tough subject to bring up, but you did it, and I think that's fantastic!

P


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