Liking the progress but needing more time to dig deeper, I asked my last therapist if we could meet twice a week instead of once. She said “No, I don’t like getting overly involved with any one given patient.”

At first I respected this boundary as healthy and admirable. But then I realized what’s really happening: the relationship is kept intentionally superficial. Rather than give less patients more, she vouched to give more patients less.

I didn’t just need another hour of therapy rando style. I needed our work to work harder. And she said no. It wasn’t even remotely an option.

Imagine your car needs serviced but the mechanic tells you he can only work on it one day a week to prevent being overwhelmed. Do you drive home with busted brakes concerned about the mechanics personal vehicles and emotional wellbeing? I sure don’t.

I suddenly felt as though I was serving her needs as provider, not mine as patient. The result was a lot of progress made initially, which quickly plateaued shallowly after mere weeks (8 visits), during which time I spilled every bean my weeping brain had to offer plus more; another notch inferior.

Had she told me this subjective restriction upfront, I would have found someone else sooner and not dedicated so much time, energy, love and heartbreak to such a limited service.

I don’t think 2 hours a week for a patient in functional-crisis is a lot to ask. She was fine continuing once a week, but subsequently pitched me intensive out patient as my go-to solution circumventing her restrictions. I found this offensively shortsighted.

Surely patients need services between 1hr a week and 20; something between leisurely talk therapy and the ER. Derailing my white-knuckled life for overwhelmingly cumbersome outpatient was not an option or clinically necessary. It was her punting her patient to someone else. Saying “I’m not willingly equipped to help you. Take it or leave it.” Apparently this was her decision to make alone.

It’s important to respect the boundaries of therapists. But this is a relationship you both participate in. Therapy is their job. Wanting/needing therapy is patients job.

Avoiding commitment to any one given patient ended up being a huge red flag for me that ended our work prematurely. I now ask about this restriction up front session 1: assessing therapeutic potential (and its boundaries) clearly and openly. Even if you don’t utilize the wiggle room, it helps dramatically knowing it’s there.

Any system-driven entity on earth eventually needs to scale (up) for growth. Good therapy can take years. Often the scaling occurs in the patients court, as we learn to self sustain using tools already taught. Time in crisis requires more finesse. Perhaps patient needed more therapy much sooner but failed to make this self-aware conclusion, all while provider failed to encourage exactly this simply to avoid their own selfish workload. An inverse incentive gets created; all at patient risk alone.

Patients and healing are the incentives. Not provider 9 to 5.

If your provider isn’t willing to dig deeper with you despite clinical needs and desires, consider finding someone who will before the need arises. Build strong relationships you can depend on scaling come life-need (within professional reason).

Ask these questions as early as possible. Not only did I lose the momentum therapy started, I had to begin all over with someone else. Which meant sharing my every vulnerability with yet another fragile stranger I don’t trust yet. Expertise unknown. Experience untested. Territory unexplored.

Too many heart-sleeves and you can start to feel overwhelmingly broken. A risk therapy often doesn’t talk about.

The casual manner in which my therapist expected me to just willingly open up to intensive outpatient was mildly offensive. I think therapists get too used to therapy in practice, forgetting the huge vulnerabilities and insecurities it creates for human patients. Sharing every fear and weakness is never easy; it doesn’t always go well. Expecting us to waltz accordingly feels misguided.

Notice a larger problem prevails: this frequency-restriction was a subjective limitation personal to this therapist. There was nothing in place to argue against her boundaries (I didn’t try). While other professionals may share this sentiment, no standard exists defining this specific boundary to patients. And what you find is many of the nuances differentiating providers nationwide are personal preferences patient must take or leave. The rules otherwise drift yet unwritten or inconsistently observed.

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