So to start, I was recently diagnosed with a non-verbal learning disorder and a mild ASD and I think that is a factor in the mismatch/issues of this situation. I recently stopped therapy and had a strange interaction with my therapist and I wanted to get feedback to see if this is normal, and to see what others think of therapy - can it work? Is it harder for people with a NVLD or ASD to find a good therapist? I started therapy a few months back, because of a number of stressors in life (relationship issues, grad school/finances, physical health issues). Prior to entering therapy, I only attempted therapy a few times in the past, and they were awful, blatantly unethical experiences (one therapist tried to sleep with me, the other expressed blatantly bigoted things about Latinos not realizing I am Hispanic). With my new therapist, at first I was thrilled basically because she wasn't inappropriate or discriminatory; however, minor things started to bother me. Details forgotten between sessions and feeling like I needed to re-iterate things I already said in the past. With this, I wondered if I was being too nit-picky; is it really a big deal if she forgets from week to week, say, what kind of medical specialist I see?
The learning disorder/ASD diagnosis actually came up with her (she kept reading my issues with eye contact and body language and stimming as anxiousness, when I was not feeling anxious, so one session she brought up that maybe these things have to do with an ASD so she put in a referral to a nearby center that offers testing to adults). Interestingly, she asked that I call to set up the appointment once she made the referral, and when I came in the next week and told her I set up the appointment like she asked me to, she responded "Why is it that you're going for this testing again?" I thought it was so bizarre she wouldn't remember so I essentially told her I am going because she suggested it in the first place, and I can't recall how the conversation went from there, but I remember this bothered me, because it seemed like a major thing to forget and a weird question to ask since I wouldn't have even thought to suggest autism testing on my own.
Another thing that bothered me with her is she first suggested that if stressors came up in between therapy sessions that I could always e-mail her. Now, my life has been a mess, and if something is coming up that cannot wait until the next session, chances are, I might be less than coherent and succinct in typing it all out. So every time I'd e-mail, it would be "too long" and the first time she brought up that it was too long, she added "I have a full practice and just can't get thru these". I felt guilty reading this, because I recognize she is busy and I was so uncomfortable with the suggestion to e-mail in the first place because I was worried about adding a work burden (I think too many people are overworked and underpaid and I don't want to add to that). Still, I stupidly e-mailed again another time, a few weeks later, over another stressor, and her response started with "Oh, What are we going to do about your long emails?" I felt dumb and selfish, and I hated this response because honestly, in the face of a question like that I would think to just not send any more e-mails. I wish she would have just said "on second thought, let's not do e-mail and address things in session" than be told I can e-mail, then get responses like this every time I couldn't sum it up in a sentence. This is one of those things where I wonder if the NVLD/ASD stuff is making communication hard - I felt confused why she would ask "What are we going to do about these e-mails?", because how could I answer this? So I responded that I will stop e-mailing and save things for sessions, and the response was that I should feel okay to e-mail, but without any guidance of what a proper length e-mail should look like. To be told I can e-mail, but then always be scolded for length, is confusing, and I feel weird complaining about this because I don't think therapists should have to answer long emails on their own time, but if she is going to emphasize that e-mail is okay but then complain about the length then maybe she needs to be clearer about what this should look like on my end?
My schedule is also very subject to change as a grad student fully in the research phase. At first, because my schedule was so flexible in terms of no set commitments week-to-week, I agreed to play it by ear for setting appointments. Long story short, this actually was too hard to meet, I'd forget what time we set for the week because it was always changing and accidentally schedule research work during a therapy session and I missed too many weeks. I felt I needed weekly sessions at minimum, so I requested to go weekly at a specific day and time. This was months ago. Every week after that, she would ask "Did we set a day and time?" and I would remind her of the day and time we set. Sometimes, after clarifying this at the end of a session, she would e-mail me later but before the next session asking "Did we agree to meet at [day and time agreed upon for weekly sessions]?" This was getting on my nerves because it felt a bit unprofessional, but again, didn't know if I was being too demanding or expecting too much from her. The last time I went in for therapy, she had 1) asked to clarify the day and time at the session beforehand, 2) e-mailed after to confirm the same thing, and 3) when I was in the waiting room, she looked surprised to see me and asked what I was doing there. Apparently she thought it was a different day of the week. After this week, she had to skip a week because she was going on vacation. In this time, I suddenly got a $1000 bill for the autism testing, which was awful because I thought I clarified that my out of pocket portion was going to be lower (or else I would've never done it, because while it's good to know, I've been this way my whole life and managed okay enough before having a name to explain what I thought were various oddities on my end). I was frustrated by this, because my folks have never been big on medical care and I have felt helpless navigating the health care system and its attendant costs for my physical things that this just felt like too much on top of everything else, so I e-mailed her in a panic stressed about this bill. Her response just made me feel like an idiot for not realizing the proper cost upfront, which I didn't expect from her (I thought I clarified the proper costs, but it turns out I was mistaken in my understanding, and being left with the costs from this mistaken understanding right before the holidays was stressful). I had some imaging done earlier in the year for physical health needs and I spent hours on the phone with my insurance company to find out the costs for that, only to be billed totally differently (much higher than the costs I was quoted) and being responsible for costs I didn't expect. I spent sessions discussing that situation and my frustration over the costs with her and in that case, she was sympathetic and understanding that even if you think you know what you are getting into, you never can really know and that I was justified to feel upset since I was so alone in figuring this out. That understanding seemed lost this time, and she seemed annoyed I was e-mailing her about this, like I should've known the costs so what is the big deal (I know, I know, I should have kept my word on the e-mail front, it just was hard to process the reality of this bill - plus, billing changed where before this year, my insurance used to cover this type of testing for free, so is it so hard to believe that in the first year of this change towards patients being responsible to pay for part of the testing that things may be unclear?). Given all the other frustrations building up, I responded somewhat shortly and said that to be honest, after months I did not feel I could come in consistently enough to get the help I need and that it makes more sense to stop therapy than continue, so to please cancel my upcoming sessions.
She sent a response back at first that was polite and I meant to respond, but right now the semester is ending and I've been swamped with grading and deadlines. I knew this e-mail would be a bit draining to write, so I told myself I'd e-mail once I've submitted all my grades.
Well, yesterday (before I could finish my grades and respond to her) I was supposed to have a session, and I think she forgot about my e-mail to cancel and was reminded when my time came up and no one was there. So, she proceeded to take the time that would have been our session to write an e-mail to me. Now, in ending therapy with her, I was under the impression that in many respects she is well-meaning and caring, and she's certainly not unethical like my previous therapists; it is more a mismatch than anything (in other respects, I felt she wasn't hearing me any time I didn't conform to her pre-existing notions of what "female grad students" are like, so I felt like she was seeing a stereotype or archetype instead of me, which was highly frustrating and not helpful). After her e-mail, I'm a little unsure of what to think, because I find it a bit inappropriate, so the biggest reason for my posting this is to get some feedback on things she said in this e-mail. On some level, I feel a bit gaslighted by the e-mail, but I also feel kind of crazy to think that. Some statements from the e-mail that I question are:
"I hope you can value my spending this time trying to gift you with an insight or two, while fully accepting that you've chosen not to work with me." (this opening sentence felt manipulative in its wording)
"Sometimes, I think, you want people to read your mind; I want you to know that you will get your needs better met if your expectation is Socratic." (this one is mild but maybe still iffy, I do not expect her to read my mind, but I admit I could speak up more, I grew up so controlled and never allowed my own voice that I started therapy also in part to address my issues stemming from this and I worry that maybe the things I am seeking therapy for have damaged me in ways that will make getting help through therapy difficult, because it's hard to feel comfortable to speak openly given my history. I imagine I must be a frustrating patient in this respect)
"Some of your upset is distorted, and I think it will serve you better if you keep this in mind when you get upset with others. I think that when you felt hurt by me (and when this happens with others), you distort some facts" (this is where I start to feel gaslighted because I'm not even sure what she is referring to in saying this and it felt really bizarre and unprompted to get an e-mail from her saying this. Reading this makes me feel like my perceptions and judgment cannot be trusted, and given my history of abuse that she is well-aware of, I think this is a dangerous thing for her to say without being clearer about what she is referring to)
"Please don't misconstrue scheduling difficulties for someone's indifference to you! That doesn't serve you well. It also won't serve you to extrapolate, in your upset, in a distortive way that causes you further upset." (I never felt that the scheduling issues meant indifference; I just tried to express feeling frustrated by her seeming to forget our weekly sessions because I felt she should know this and that I was falling behind when I had to skip sessions, but I've never felt or expressed that she is indifferent so I was surprised by this. I found the wording of "that doesn't serve you well" also to be manipulative and off-putting).
"Finally, try to keep in mind, when you're feeling "ignored by" or "invisible to" others, the larger canvas. My double-checking our appointments might have upset you, but I also went well beyond standard clinical form in always answering your (sometimes lengthy) emails promptly and thoughtfully, and I did this specifically because I felt that partnering you in this extra-curricular way could be important/healing in our work together. If you can remember the "larger canvas" with others, you'll find more ballast in your life. I hope this email doesn't upset you. My intention is the opposite." (I've always recognized "the larger canvas", as she put it, but I'm bothered by her mentioning the e-mails thing as some pat on the back here, because that's exactly how this reads to me. I don't think she should do extra work unpaid for anybody and I recognize she does not have to do this, but when most of her responses to my "lengthy" e-mails were to say they were too long, it would have been more clinically helpful to be told "don't e-mail". I'm also bothered she closed with the "I hope this doesn't upset you" bit, because I think it shows some recognition on her end that this e-mail was inappropriate and would be upsetting and I think she should have taken this as the sign to not hit send).
On some level, I think she was just pissed she forgot I told her to cancel this appointment, and sent this as some weird passive aggressive thing and I shouldn't take it to heart. But it really makes me distrusting of therapists, I find it so hard to navigate social situations generally and therapy just feels like another weird social situation that I am clueless to navigate, so I am looking for feedback on this situation and advice on how to find an effective therapist in the future from others who may have NVLDs and/or ASDs, because the bad experiences end up doing more damage than no therapy at all. To get therapy affordably, I basically need this woman to give me a referral out, which she will do, but I might want to research my options. Would reaching out to a nearby organization for autism spectrum disorders (when I received my diagnosis I was told I qualified for services through this organization) and asking for therapist recommendations make sense? Should I ask the person that administered the diagnostic testing for their thoughts on this situation? In this latter case, I'm just nervous the testing clinician is friendly with my therapist and wouldn't be understanding of my experience. Thanks for taking the time to read/listen.
21 Dec 2016, 1:25 pm
I would be able to point you in the direction of reading materials for anything you might be interested in finding out more about. And that would be free.
