Vulnerability and therapy

[jdcooper]

So I am working extremely hard in therapy, maybe even a bit obsessive-compulsive.  Reading numerous books, reading posts , posting, on this forum and others.  Analyzing, journaling, grieving etc etc.  I learned here that lots of people who were giving their therapist who don't know about CPSTD the book by Pete Walker.  I briefly mentioned CPSTD to my therapist months ago and she didn't know what it was and I gave her a brief answer and we never spoke of it again.

Yesterday, after rereading the book and discovering all kinds of aha moments, I decided to give the book to my therapist.  She said to me, "How long do I have to read it?"  I said something to the effect that she could just skim it and I had underlined some things-not really answering her question.

Later after the session I began feeling really vulnerable.  I felt like I am making my therapist do homework and that she might resent it.  I also felt like maybe she won't think the book is worthy of her attention.  Then thoughts of how its all going to play out.  Do I really want to be diagnosed with CPTSD?  or do I just really think there are great insights in the book about things that I am going through.

Another problem is that my insurance pays  less than other insurance companies do for her services-maybe $15-25 less.  So I struggle with not working her too hard.  The only reason I know my insurance company pays less is that she has mentioned it.  She mentioned it and than quickly said she wasn't that concerned with money at this point in her life, she is semi-retired.  When she and I discussed that at maybe some point my husband and I may need some family therapy she said - you need to find someone good and with your insurance that might be hard.

In general, I feel vulnerable and I didn't sleep last night and I am wondering why such a big deal about a book? Where is this feeling of vulnerability coming from?

[Blueberry]

If your T is even open to being educated a bit by you on C-PTSD, then that's good. She ought to be able to set limits if she needs them. It's certainly her job to do so and not because she's a therapist but because that's any adult's job!

Maybe in the past you asked people to go slightly out of their way for you and they either refused or attacked you somehow even just verbally/emotionally. That could make you feel vulnerable now. Or maybe asking somebody (possibly in addition somebody in a position of authority) for a 'favour' is pretty new behaviour for you. That can make us feel pretty vulnerable too.

[radical]

We are all vulnerable in therapy.

What you've described here makes me feel edgy.  I think the money situation could be important.  I know from my own experience, that inappropriate amounts of gratitude can make us extra vulnerable. Like anything else, feeling grateful needs to be appropriate - it can be both too little and too much.

I don't know if this is an issue for you, in this situation or any other.  I'm really just putting it out there. Excessive gratitude to the point of feeling beholden for any minimal, or infrequent experience of consideration, or for not being actively hurt, can be a part of dysfunctional fawn/appeasement problems and create extremely unhealthy dynamics in our relationships with others.  People who have experienced severe, prolonged rejection can be particularly susceptible to this problem.  Over-gratitude and lowered discernment towards anyone who seems to be friendly, can even be manipulated experimentally, where subjects are made to (temporarily) feel they have been rejected by others.

I think it is a good idea to discuss the payment issue more fully, especially if your insurers payment means you feel  indebted.  You clearly feel uncomfortable. I realise this is an awkward subject for most, but therapy is supposed to be a space where difficult subjects and feelings can be discussed.

It makes sense, again, from my own point of view, that you have raised this in tandem with feeling uncomfortable about giving your therapist the book.  Personally, I don't think it is fair to ask your therapist to read a book in her spare time.  What I feel might be a better way of dealing with it, is spending a session going over the points that are most important to you and discussing how this framework fits with your therapist's modality and understandings.

If your therapist has a problem with this, isn't prepared to take something that is important to you seriously, that might give you important information.  You might need to decide if her framework has in the past, and is likely in the future, to  be a good enough fit in meeting your needs, and if it encompasses a full understanding of the problems of interpersonal trauma, and trust seriously damaged by betrayal.

This is your therapy, and what is important to you is what is important.  We need, as therapy clients to feel a real sense that we are equal adults, regardless ot the vulnerable parts of ourselves we also bring to the table.  Clear communication is essential.  It's so easy when we've been badly hurt to become passive and unassertive, to hint rather than speak clearly about our needs, to hope for the best rather than take an active role.

[jdcooper]

Thanks for your reply Blueberry-this is what my husband said-that it is for her self education on a new topic in the field of treatment for people like me. 

Radical, she replied to a text, I sent this morning, inquiring about the book and my expression of vulnerability for having given it to her.  She said she was delighted I wanted her to read it and that I am working very hard in therapy; that she didn't have time to read it cover to cover but could skim it and we could talk about it.

She did not address the insurance issue which I brought up in my text.  This is an issue that is bothering me, a lot.  My father always cared a lot about money. He did not help me through college; I got student loans when needed; but when I wanted to go on a trip to England for study abroad and my grandmother talked him into helping me all I got was rage and rejection thrown at me.

When I got out of college I was pretty desperate as I did not have a car and he gave me a small loan.  The terms for repaying it were not discussed.  When I didn't repay him in the time frame he wanted (without expressing it) he wrote me a letter berating me for not paying it back and that I had been the one to damage the relationship because of it.  I promptly paid him back.  He made me feel ashamed and bad that I needed that monetary assistance.  He never came to my college graduation and I feel like he still resents the money he had to pay for that one trip abroad.

I am definitely equating my therapists view of my "poor insurance" as a feeling of vulnerability in our relationship.  In the beginning of this year I had not met my deductible and paid her for three sessions in cash.  She was so late in filing the claims that by the time the insurance company got them I had met my deductible and she got paid for them.  I told her to keep the extra money paid to her.  I felt like I was at the very least making up some of the difference between what other insurance companies pay and what mine pays.

I had a horrible therapist before her who took my insurance.  (As well as a couple other bad ones a few years back that I had 2-3 sessions with).  He was so so bad.  The therapists on my panel of chosen therapists - from looking at their websites seem extremely unprofessional looking and lacking in any substantive credentials.  Many were not my race (I know that sounds racist and I am not, I just don't know if the comfort factor would be harmed by having different racial experiences)  I found her website and was relieved she was a PHD and is a former professor at my alma mater. 

I am so scared to even consider another therapist that I feel like I MUST resolve this feeling of me being a burden or not worthy or some other derogatory thing that my painfully vulnerable brain feels.

For some reason this stage in my therapy is really pushing all of the buttons - I am not sleeping and this is despite taking sleep medication that should knock just about anyone out.  I have never had a female therapist before and my mother was extremely neglectful because of mental illness.

So between having a female therapist and being open and vulnerable to a woman for this first time in my life to my feeling bad about the money issue because of my cheap, uncaring father it is just really hard.

Also this is the rate she negotiated with the insurance company and by being on their panel of approved providers she probably isn't allowed to charge me anymore for the sessions.

[sanmagic7]

hey, jd,

putting myself in your therapist's shoes for a moment.  if it were me, i'd be happy to read the book, learn about something with which i'm not familiar that would help my client, even if it's the underlined parts that seem important to you so that we could talk about them in session.  i have a red flag about the money issue.  if i negotiated with the insurance company on what i'm to be paid per session, that is between me and the ins. co.  in my mind, that has nothing to do with you, and i would never bring it up to you. 

the reason i wouldn't bring it up is for exactly what you're going through because you know this has happened.  you don't need to be burdened with money issues - you are in my office because you are in distress, and are looking to me to help you find your way to a goal of having a less distressed life.  laying money issues on you seems counter-productive to me in that regard.  the proof is in your pudding - you are more distressed for knowing about it, which isn't helping your treatment.  in fact, at the moment, it's making it worse.

a similar situation my hub and i dealt with was when he was in a hospital here for surgery.  2 days later, his doc went to him, complaining about not getting paid in a timely manner.  that wasn't supposed to be a concern of my hub's - his concern was to heal after surgery.

you don't need to concern yourself with your t's money issues, either.  her payment, as per her negotiations, are her concern, hers to deal with.  i'm very sorry you were dragged into that discussion.   you've paid extra, more than you needed to, because of past issues with your father, and are losing sleep over this.  i don't see how her telling you about ins. payments has benefitted you or made your recovery easier.  in fact, i see it as quite the opposite.

you deserve to get the very best therapy possible from your t, regardless of how much she is getting paid.  some t's will do pro bono work, some will work on a sliding scale, some refuse to work with ins. companies, some only take ins. clients.  t's and their payments are their personal business, and should have no bearing on the quality of treatment you receive.

if you find that it may make the situation easier, or that it will help you put it away, you can talk with your t in your next session about what hearing about the money issue triggered in you, and what distress it has caused you.   i'm just sorry you're having to go through this.  i think it was a mistake, and as such, can be rectified through discussion.  best to you with this.  i hope it goes well, and, if you feel like sharing, let us know.  big hug, jd.  p.s.  some t's don't discuss private stuff in emails because of confidentiality's sake.  the internet is not secure.

[radical]

In the beginning of this year I had not met my deductible and paid her for three sessions in cash.  She was so late in filing the claims that by the time the insurance company got them I had met my deductible and she got paid for them.  I told her to keep the extra money paid to her. I felt like I was at the very least making up some of the difference between what other insurance companies pay and what mine pays.

.................She did not address the insurance issue which I brought up in my text.

It worries me that she was remiss and you felt the need to appease her.  If it were me, the guilt and anxiety in my head would go something like: "it's such a drag for her to have to fill in forms when she has so many more important things to do.  She might feel resentful in having to do this paper work for someone she gets less money to see.  I'm a burden, other patients are more rewarding and less work, I have to find ways to make up for the problems I am causing her.  I'm not worth it, I'm so lucky some-one with her talents is doing me such a big favour.  I need to make sure she doesn't regret it and resent me.  What can I do to make it up to her so she doesn't dump me in favour of someone more worthwhile?". etc.

My concern is that if there is anything about your therapy which is triggering a feeling of being 'less than', I feel it is an issue that you need to be able to be able to talk about openly without fearing that possibility of offending your therapist.  It sounds like this issue is really painful.

I understand your feeling anxious about the text from your therapist.  You brought up two issues which were troubling you.  she responded to one and ignored the other.  What she could have done is texted something like:   I'm glad you felt able to raise these worries.  "I don't feel put out, just happy with how well you are doing. I look forward to being able to talk more in our next session.  I'm sorry I don't have enough text space to be more helpful now."

If she felt the need to reassure you about the book, and was unwilling to talk about money by text, or didn't have the time or space to talk about both, she could reassured you that she heard you were worried about both and was happy you'd raised both matters, and looked forward to being able to talk more freely and in more detail in your next session.

The problem is, we communicate with what we say and what we don't say.  I'm guessing having one fear allayed, and the other left unmentioned may have actually increased your anxiety about the other.

I really hope you are able to talk about how you feel and get the reassurance you need.  In light of how money has been used to manipulate you and make you feel inferior in the past, this could open the door to some healing

All the best.

[jdcooper]

Radical, SanMagic, Yeah,

She definitely should not have brought up the insurance paying less ever. She agreed to take my insurance from day one (after all she is on THEIR PANEL) and never once mentioned it until much later when I was already an established patient.  It should be obvious to her that that would make me feel bad.  Maybe because I am an attorney and have made good money in the past; had my own practice like she does, she feels like I would understand all the ins and outs of insurance and how that world works and is just commiserating with me.  I have had clients who I charged less and then regretted it-maybe that why I feel so bad.  I feel like she is regretting taking me on as a client, but now has to live with it.  I also know she takes insurance from other people.

I mentioned once to her that my insurance would no longer cover an antidepressant I was taking and she took another opportunity to say "how bad" my insurance is.

She definitely has a huge blind spot around money issues.  I think she is very conscious of money in her own life-self made woman and all that- I am pretty sure she lives alone without a partner.  She also wants me to be more independent from my husband, and have my own job with my own savings (retirement). She once went on and on the extent of what was my own money in the marriage to the point of making me feel bad.  I did bring that up and she apologized and never brought it up again.   She is a feminist, not married, etc.  She has seen too many women dependent on a man and sees how that affects them.  I agree with this wholeheartedly, I was raised by my dependent mother, to "never depend on a man."  We are working very hard to get me back to working and being more independent.

In her text she said, "I invite you to ask me anything you want to and we can discuss my answer"  So she is opening the door to discussing it.

I could actually afford to pay her the difference between what other insurance company pays and what mine pays; I am not sure what her agreement with my insurance is, but I have felt like offering to at times, but she has always said she doesn't care about the money at this point in her life.  But then she contradicts that in her statements about my "poor insurance"  Also she seemed very pleased with the extra $180 she got recently.  That lifted my burden and bad feelings for awhile.

I disagree that I have poor insurance.  She is semi-retired with few patients.  She may not see the trends in insurance.  My insurance company pays for unlimited visits to a therapist weekly with no copay once deductible is met.  It also pays for very expensive treatment for my son who has ulcerative colitis, his drugs alone cost over $1000.00 a month.  My husbands back surgery and prostate surgery recently were extremely expensive-again with no copay.  None of our other doctors have complained about our insurance - I am sure they just accepted the negotiated rate that they have to accept from most insurance companies.

I know she hates insurance companies, hates the forms she has to fill out etc.  She is 73 and it is part of her practice that she hates and I am not sure why she doesn't just give that part of her practice up if she doesn't need the money.

My husband thinks I shouldn't bring it up again unless she does.  He thinks we gave her the extra $180, she is pleased and just leave it alone unless she brings it up again and then mention to her that she has brought that up before and why does she keep bringing that up.

Aside from all that "money stuff"  she is a very good therapist.  She is the very first therapist to discover that I have been abused as a child (I blocked it all out) and that was later confirmed by my mother).  I have had very warm and grateful and close feelings towards her that I know have been very helpful in recovery. We talk about politics in the context of Narcissists and we are completely compatible in this area and bond quite a bit over it.  I do think that If I brought up the insurance issue she would back down for good and never mention it again.

I guess that all therapists have their blind spots and part of the work of therapy is to work out these rifts in our relationship.  No therapist is perfect but believe me when I say I have had much much much worse.

In fact I had a therapist who I saw for a couple of years who ended up abusing me (in his counter transference he mentioned he had sexual fantasies about me) It was  a HUGE BETRAYAL.  As you can imagine then that every therapist who works with me has to over come trust issues with me.

If I didn't have trust issues I could probably see this is a kinder gentler way.  She is a very kind woman with a blind spot around a certain issue.  The fact that I am so distraught over this is my subconscious attempt to see things in black and white.  She is either a GOOD therapist or a BAD therapist. My husband pointed out that she is a good therapist and it is MY issue etc.

Thank you for listening and responding to what has been a difficult trying issue for me that I am attempting to understand.

[sanmagic7]

i think therapist's suggestions for you and your life, how to live it, etc., are valid, but not to the point where you're being pushed so hard that you feel bad.  i'm not saying she's not a good therapist, but i am glad that you are able to stand up for yourself.  she is not the authority on your life according to her perspectives, perceptions, and belief systems. 

to my mind, this whole money thing is something for her to deal with irrespective of you.  you don't belong in that discussion, and you don't even need to bother yourself with it.  you're there, enlisting her help for your own issues, not to be concerned with hers.  and, as far as i can tell, your ins. co. seems like any ins. co. in that some areas are covered better than others.  i think the fact that it allows you unlimited mental health coverage is great!  that certainly hasn't always been the case - i know that from experience.

so, whatever you decide to do, jd, you have my support.  if you want to follow up with the money thing with her or not is up to you.  my opinion is that if you can put it aside now, not be bothered by it anymore, it becomes a non-issue for you, and you can move forward with other things.  if it continues to tug at you, i think it would be good to bring it up at your next session in order for it to get resolved so you can move on from it and tackle your other issues in order to continue to move forward in your recovery.  that, to my mind, is the most important.   best to you with this.  big hug.

[jdcooper]

Well since it is bothering me and I already opened the door I think I should bring it up. My husband is absolutely clueless in issues relating to therapy and sometimes gives me terrible advice.  The fact alone that this post has gone on as long as it has tells me that this is a troublesome issue.  I have to confront my fears of offending her and accept the fact that she may not be able to reassure me in the way I need.

If she can't reassure me, then I have to consider paying her more to equalize the power imbalance that I feel. Thanks for your input Sanmagic, since you have that therapist background it helps me to see things from that angle.