been in psychotherapy for approximately three years with my current
psychotherapist. . . . I was also in psychotherapy with her
approximately 10 years ago for about one year. I left my first round of
psychotherapy . . . because I left the area. . . .
Originally I began to see her due to severe depression, anxiety attacks,
and bipolar II issues. When I began to see her three years ago I went back
because I was in an immediate crisis . . . and needed the help
no matter the cost.
She has helped me dramatically, not just with my presenting problems, but
with deep issues that have prevented me from being happy. I feel I have learned
a lot of things and have changed many ways of thinking. I am now able to
do a lot of things for myself (emotionally) that I originally needed her
for. I have also been able to make many positive changes in my life. I do
still feel, however, that I have a long way to go.
I find myself in a situation where I am having difficulty paying her. I have
considered seeing her an investment ($180 a session, weekly session, no mental
health insurance) and it has been a wise investment. Ive been able
to make changes in my life that I wouldnt have been able to make otherwise.
I talked with her about seeing her twice a month as opposed to weekly.
I feel very angry and confused and sad about my conversation with her regarding
my seeing her less often. She told me in the past that she identifies with
me and that my problem of suppressing emotions to the point of truly not
even knowing that Im having them was one of her main issues in her
psychotherapy as well. She has said that she cares for me and feels a genuine
connection with me that she thinks we would have if we had met under different
circumstances. I feel there is a genuine connection and I do believe she
is concerned for my welfare and happy with my progress. When I talked with
her about not seeing her as often yesterday, I didnt ask her to cut
her fee, but she said, I wish I were a wealthy woman where I was able
to offer a sliding scale fee to some of my clients, but I am unable
toespecially because of my health situation and all the work I missed
last year. (She did not work for approximately two months.)
We did not have time to discuss her comment as it was the end of the session,
but I am very angry that she is not willing to cut her fee. It makes me feel
that doesnt care for me and my progress as much as I thought she did.
It reminds me of my parents, who care about me, but have never been there
for me in any emotional way that Ive needed them. It reminds me of
my mother, who cares about me, but could not get over her own issues to even
ever hug me. It feels like she cares about me only if Im paying. Seeing
her has been a great financial sacrifice and I feel if she really cared about
my progress like I thought she did, she would be willing to sacrifice some
tooespecially considering I make a fraction of what she makes. One
of my friends and my boyfriend are both practicing psychotherapists and have
said that they have cut fees in similar circumstances. My friend said that
with one client she truly enjoyed the work she did with the that client and
cared about her progress, therefore she was willing to cut her fee.
Ive looked around on the internet, but have not been able to find
information on standards and guidelines to fees/cutting them/changing them/etc.
From a business standpoint I understand my psychotherapists position,
but I also feel that if she cared and identified with me the way she said
she has then she would be willing to cut her fee. On the other hand, I think
that my boyfriend and friend may be telling me that they sometimes cut their
fees to show empathy towards me and arent looking at the situation
objectively. And beyond all of this, Im also not sure I can feel intimate
with her in the future because of this situation.
There are actually two issues here.
First, the issue
about the treatment fee represents a metaphorical obstacle that you have
derives from what can be called a fundamental narcissism of human
life. I refer here to the fact that every child born into the world goes
through a psychological phase in which it feels as if he or she is the center
of the universe. After all, for a child to survive, he or she must receive
a great amount of attention from the parents. But eventually, to achieve
a mature relationship with the world, each person must learn that it
is not the task of the world to know that I exist, it is my task to know
that the world exists. Thus the child will be able to locate itself
psychologically within a network of social relatedness and responsibility,
thereby outgrowing a preoccupation with the self.
the child does not receive adequate attention initially, then the child will
carry on into adulthood a certain unconscious
anger at having
been short-changed, so to speak. In other words, when the childs initial
are not met properly, then his or her attitude to life will remain stuck
in a sort of narcissistic short circuit: a preoccupation with making the
self feel important as an
fueled by the constant bitterness and resentment about what hasnt been
received. Thats what depression, anxiety, and mania are all about,
anger turned inwards; anxiety is a fearful preoccupation with what is lacking;
and mania is a flight
into an imaginary feeling of self-importance.
In the present
case, your resentment about the treatment fee represents your resentment
about having been short-changed by your parents. Your task in psychotherapy
is to understand how that emotional short-circuit causes so many of your
then to resolve the problem by facing the pain of the original wounds, whatever
Second, you say
you have a boyfriend. Well, if he really cared about you as he
most likely says he does, then why isnt he helping you pay for your
All of which
goes to show that healing from fundamental narcissism does not come from
others caring about youor loving you. This
common love is
just a form of bribery to make you feel desired, and it will always fail
in some way. Healing comes from your willingness to give real
loveemotional qualities such as patience, forbearance, compassion,
mercy, and understandingto others despite the pain and
disappointment they inflict on you. And you achieve this healing because
a psychotherapist cares enough about the work to
do a good job helping you.
So, to learn
real love, it is necessary to learn to pay the full cost of life. Once you
learn to give real love, rather than be stuck in the resentment of
not feeling loved, your wounds will be healed, and your defensive
symptoms will dissolve.
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