Hi Cat,

My DBT, who I see at the "encouragement" of my T does not take insurance and charges a pretty penny that I can't quite afford. I currently see her once a month, which is all my budget can handle (I see my T twice weekly, though, as that is covered by insurance, thankfully.)

Recently, I did a little math. Knowing the basics of DBTs schedule, I calculated how much DBT charges, times how many clients (on a low guestimate) seen per day, times how many days per week worked. Based on that calculation alone (which I know to be relatively accurate) and not including the DBT groups hosted, well, DBT makes at least four times what I make (after office expenses are taken out) and when I wrote my check this month, it was a lot harder to do so knowing this.

Yes, I get the whole "pay for their expertise" perspective, but sometimes, I feel you gotta take other factors into account, and that doesn't include how much JoeT down the street charges.

Cat, Your post made my blood boil. I think your T was completely out of line with her reasoning. In my opinion, Ts are not in this profession for the money. I live in one of the most expensive areas of the US and when I began to face financial problems my T told me he would not stop seeing me, but was willing to reduce the fee to what I could afford.He charges a hefty fee for a 45 minute hour normally and is very popular and could have "dumped" me nicely; got a full-pay client and moved on. He takes no insurance. I see him twice a week and he could be making more money without me. His integrity is very much intact. He is very well off but is not flashy and he is secure enough in his ability where he knows how to exercise discretion. The therapy is that important to him and he knows I am dedicated and he values that commitment a great deal; which says a lot about his character. I would have felt extremely hurt and insulted. Somehow her response sounded to devalue your therapy and came across a bit arrogant. The T alway can use discretion, even see someone at no charge if they see fit. I have heard of this many times. In five years my T has never raised the rate. Good luck to you. I hope my response did not offend you. I feel for you and would like to smack your T up the head.

(((r2g))) I like what you said about "JoeT". It's very frustrating. She's had a pretty sweet lifestyle (monetarily) since a young age given some of her stories. Her siblings - at least one of them - is a bit famous and I know he makes an insane amount. Anyway... It's hard not to be bitter given the reason. It makes sense she wants material wealth. The first time she raised it was about wanting to value herself. It's about every 6 months she will raise it another 10% I don't know why she just won't up it $50 or $100 in one shot instead of this bull. I know I see plenty of wealthy professionals and I'm sure they have all kinds of properties and cars and whatever. I just wish I understood why I let this be okay but if it was ANY other service I would be out the damn door. It makes me think less of her for her to be what seems needlessly in a quest for material wealth... But that's VERY much the culture here, she deserves to be comfortable and do whatever she wants with her business. She'll stop raising when people stop paying.

(((VH))) thank you for sharing my annoyance! You didn't offend me, from what it sounds the vast majority of people's Ts here don't do the same mine does, so I was anticipating the majority of responses to be from people who do get concessions or no rate increases. My T has strict boundaries, but is also very generous with her care, love, attentiveness within that frame. As I frustrated I try to remember to tell myself love does not equal money, money does not communicate care... Money is not to punish or praise. Her care comes in hugs and holds and reminding me of her loving thoughts or thinking of me or checking on me... She gives a lot it's just money is such an f'ed and sensitive thing. I hate it.

(((Cat)))

Money really is a sensitive issue. I have added up in my head about what my T makes in a year, and...it's probably 4 times what I make. I recently had to cut back to one session a week because I was spending the equivalent of two car payments on therapy per month. Seriously, my son's full-time daycare costs less.

I think the inherent injustice we feel over this issue has to do with the clientele. If I could charge what I want for what I do (I will someday), of course I would charge a premium. Many of my clients would be businesses that could afford the high rate. But Ts see people who are hurting and often struggling. Of course, Ts are well-educated, licensed, and the best ones are very skilled and highly experienced. I can understand charging for that. But it does often mean that those who most need the help are unable to get it.

Honestly, the whole healthcare business (especially in the U.S.) stinks to high heaven. If you're wealthy, you can get the care you need. If you're minimum wage or middling, you can almost forghettaboutit. Insurance alone will just about break the bank. Mine has a $2,500 per-year deductible PER PERSON that I have to meet before my insurance will pay a cent in copays. Oh, and my therapy visits are limited to 30 per year. I'll hit my visit limit before I reach my deductible. How convenient for the insurance company.

I blame the system.

Cat,

I've been thinking more about this issue, and I wonder if your T is being a bit unethical in raising fees that often for all of her clients. Usually, fee raises only apply to new clients while current clients stay at the old rate. Maybe she is doing the 10% raise every six months in order for her lower-fee clients to gradually adjust, but I seriously question her ethics in raising them at all. The more I think about it, the more uncomfortable I feel. Just something to consider.

Of course, if she grew up in a comfortable situation, she may not even be aware of how much difficulty this is causing for her current clients. It doesn't make her a bad or uncaring person at all. She may really just not get it. And living in the area that she does, freezing fee hikes for current clients may not be a common practice.

I'm so sorry you're in this situation, Cat. Hugs.

I'll reply more later but I read about it and Ts have the option to raise everyone or raise new clients only - and keep others at reduced or free or whatever they want to unless contracted (with insurance - which my T is in no network). They can also increase them whenever - just as I could go to a store and the same chocolate bar I bought yesterday is 25crnts more, and 15 cents more on top of that the next day.

It makes me feel like I'm doing stuff wrong in therapy that I can't easily say well.:: not shopping here anymore! Her service, considering the amount of time I already have invested is valuable... and it's worth much much much more than I could ever pay... that I'll keep paying it but it hits hard. I wish my T's life/lifestyle and reasons didn't bug me, but they still do.

I think because she is going on vacation very soon... that I am getting angrier or angry at all because of an unconscious desire to push her away. That is where I hope a lot of my anger is coming from.

I've seen a couple people reply and then remove their comments (((hug))) so I'm sorry about anything that is triggering.

Hey Cat - it would upset me too. That's possibly not comforting right now but you have my empathy, anyway. My T does a sliding scale and I really like her values about it. It helps.

((((CAT)))))

Just sending hugs. Just another one of those yucky therapy moments that seems to undermine the therapeutic relationship when we have to deal with something we would rather not deal with. It sucks.

(((Cat))) I agree that would be hard for me, those sort of regular increases, especially if not really needed. Like, I might understand if a T said, "Well, my overhead just went up, because rent for this space went up," or something. But, it would be hard otherwise. I'm one of those whose T will do a huge sliding scale with people, even see someone he doesn't know who is in crisis for free. He always thanks me when I pay and when I've joked it's kind of part of the deal, he said he's never pursued someone who owed him either...it kind of amazes me, and I don't know if it's his generosity, his administrative failings, or both, lol.

On the other hand, it can be hard to discuss financial hardship with him (like we were having with the insurance for a year), because he knows what H makes and doesn't see why we can't afford it better and then I feel like a total financial fail, because it's basically all this debt from remodel, cars, etc. before we lost our home, past bad decisions or decisions made when we had two incomes, and it's hard to feel accused that I should be able to afford more and like it was my own failings that got us here, or like maybe I'm taking advantage of him. Anyway, I guess, the financial aspects of the relationship are really hard, so I can understand how triggering it would be.