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Thursday, June 19, 2014

Do Not Disturb Further



Ferdinand Ries here is a composer and contemporary of Beethoven. I was struck by his face in the original portrait, and his eyes especially, which looked a bit lovestruck to me. And when I realized that I had unintentionally drawn his lapels in the shape of hearts, I had to call this one Ferdinand Ries in Love.

It's been a weird week. I've had the most bewildering exchange with a therapist ever. I saw this guy's info online - let's call him Marc - and he seemed pretty impressive. I was struck by his focus and description of his own methods on his site. He mentioned that one of his specialties was helping people in the aftermath of job loss, and he also had a bullet point on there stating that the initial session was free. Sounded good to me.

His name was French, first and last. I wasn't sure if he was American or French. In our first email exchange, I asked him if he might have something open that week, if he took insurance, and one other question I can't recall. His response was, "Yes from all three," and he said we should go ahead and set an appointment.

I felt sure the guy must be French. "Yes from all three" was probably a simple grammatical error, like the kind you'd make if you were still learning English. I was actually kind of looking forward to having a therapist who was a gen-yoo-ayn French fella. A French therapist would have to be the complete opposite of an American life coach, for instance.

I had a life-coach therapist once - a guy (let's call him Stan) who kept telling me, when I had problems at work, to just "be the lion" with my boss. "Be the lion!" he'd yell. Sure. Easy to say, harder to do. And what does that even mean, anyway? When Stan wasn't yelling at me me to be the lion, he was telling me I should: "Do whatever your boss wants!" He seemed unaware that these two approaches might have anything contradictory about them. He used to reach behind him where he had a bookcase full of fat tomes, and would pull one down and thwack it open on his desk. "If you don't believe me, look at this! IT'S RIGHT HERE!" We didn't last long, but he was helpful in steering me away from easy-fix, you're-a-winner-except-when-you're-not approaches to therapy.

I figured the French dude would be a deep-delver, not superficial. He might even be open to interesting philosophical chats. There's nothing you couldn't say to a French therapist. I was ready to roll up my sleeves.

Marc, disappointingly, turned out to be American, though (I assume) of French extraction. His face was long and he had large eyes. He looked sympathetic, and the signs that he was a new-age guy - dark red shirt, candles on a side table - seemed to bode well for the likelihood that he was not a life coach.

Marc and I had one session, and it went well enough that I wanted to  continue. There was one strange moment when I asked him whether the first session was free. He gave me this long, sad, searching look. "You saw that?" I felt I had made some sort of stumble, but wasn't sure why.

I said, yes, I had read about the free initial session on his web site, and wanted to find out if it was still true. Therapists are not always great about keeping their sites updated, and since he hadn't mentioned it yet, I figured I should get clear on it. He said, "Yes, well, the session is free to you.  But I'll be billing your insurance for it."

When I called my insurance, they told me that Marc was out of network, and that I would have to pay up to a largish deductible before they would start covering a portion of the cost of my sessions. I emailed Marc to let him know that since my insurance wasn't going to be covering my sessions for a while, and I didn't have any income at present, I would need to delay starting therapy until I could pay his fees. I confirmed that I would pay him myself for the first session, and was positive and pleasant. In a second message I gave him my address, so he could send me the bill.

I expected him to say, "Sure, no worries, looking forward to seeing you again when you can resume," or whatever. But his response seemed a bit panicked. He said I should definitely come back immediately, and he would give me a reduced rate - some percentage off his fee of $140. He explained that the first-free-session thing would only work if I was seeing him and paying up to the deductible. It would take about ten sessions to reach that point.

I had sent him a second message giving him my mailing address for billing purposes, and he had responded individually to this in a tone that seemed pissy to me. No greeting, but just: "Didn't you ask for a free session?"

I was a bit stunned. I shot back, "I didn't ASK FOR a free session. I had seen your offer on your web site, and I asked about it to find out more." I told him again that I would have to delay starting a program of therapy until I could pay for the sessions. I also said I needed confirmation that I was cancelling next week's session in time not to get billed for it.

He responded with a complaint that I seemed "upset" in my message. He conceded we might be able to resume sessions at some point, but only if he had something open then. (Oh great, the scarcity-anxiety manipulation, gotta love that one!)

So the free session, according to Marc, is like a cereal box prize you can claim if you're clever enough to spot it on the web site. His interpretation of events was that I had asked him for the free session, and then he had (magnanimously!) agreed to it. So we had had this secret dance about it in his mind. All of this, of course, was something I'd been unaware of. The hidden assumption, I now know, was that I must stay in therapy long enough to reach my deductible. This is why the guy's face fell when I mentioned the free session. He knew he'd be left holding the bag for the amount of the fee if I didn't come back.

It would be so easy to protect himself from this eventuality. Why not be transparent? He could easily put a piece of documentation together that includes some boilerplate such as: "If for whatever reason the client chooses not to continue after the first session, then he or she will forfeit the free initial session offer." Simple. A therapist is a small business owner. Compensation should not be a gray area.

He seemed so weird and put out about the whole free session thing, though, that I decided I would just pay him for it, and I told him as much in my first email. But he says: "I don't remember you saying you're going to pay for the first session. I remember agreeing to free first session but my memory is not always accurate. Do what you think is right."

I read that and instantly turned into Munch's The Scream.  I cut and pasted my promise to pay him from the previous message, and told him that he already had my billing address.

And the poor memory thing - omfg. Having a poor memory, for a therapist, is kind of a big old red flag. I mean, you're a therapist! 

A person seeking therapy is emotionally fragile. It takes courage to walk through that door and start spilling your guts to someone you don't even know. The therapist has an obligation not to make things worse by being less than transparent about the financial aspect, or any other aspect of the process. Look, Dollface, you're a healer. First, do no harm -- or, as the cartoonist and philosopher Callahan put it, DO NOT DISTURB FURTHER. Be clear about your terms of service.

I'm not saying the guy wasn't within his rights to set any stipulations he likes. He just needs to be clear about what they are.

And he wasn't even French! [cries]

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