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Counselor (LSW) vs Psychologist


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So my work has an EAP program. I used it two years ago, and am using it now to see the same counselor (llicensed social worker). However, I was thinking I could benefit from seeing an actual psychologist.

 

Does anyone have experience with both? I actually have an appointment Tuesday with a psychologist, and my next appointment with the licensed social worker is in a week (Thursday). My EAP won't pay for the psychologist.

 

To give you a better picture of my background, I am the adult child of an alcoholic, and also an abuse survivor. I feel that these things have greatly impacted my romantic relationships.

 

I've really wanted to go to Overeater's Anonymous for years, but think I'm afraid (I've struggled with weight since in elementary school). Because I'm afraid to go to OA, I've also thought about going to Alanon or Adult Children of Alcoholic meetings, but always find excuses not to go.

 

I'm so tired of struggling emotionally. I don't want my life to be perfect, but I don't want to keep repeating the same mistakes. I want to fix me once and for all. I understand I'll probably always be a work in progress, I just want to feel like I'm 5-10 steps ahead of where I am today, at age 37.

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My experience with counsellors is that you need a few sessions just to get going and they never give you enough to complete the job. IF you can afford to pay, its different but with a global recession on, few people can and are unwilling to deprive their families to pay for it.

 

Good luck.

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I have been to both. I went to a psychiatrist as a teenager for sexual abuse. I don't remember my therapy at all but I feel it has benefited me. And I see a therapist now for the past two years and she is excellent. She is a LCSW. And she deals specifically with women who have suffered abuse. She has made a lot of therapies available to me. CBT, talk therapy, somatic healing and even set me up with an EDMR therapist. And I did 10 sessions of EDMR .

 

Both have their benefits.

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"Because I'm afraid to go to OA, I've also thought about going to Alanon or Adult Children of Alcoholic meetings, but always find excuses not to go."

 

Go for it.. just give it a try. Get out there and try it YOU never know, you may really come to like that kind of 'support'.

Make a date to go there and just do it!

Never hurts to try....

 

I remember, last year, I was in 1:1 therapy then was put into a 'group therapy' for about 8 weeks. It did help- a lot.

I got to see other's in the same boat as me and they were understanding and supportive.

That could be something very beneficial to you.

 

Deep breathes.. calm.. you can do it. good luck!

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Therapy brings with it a fear of the unknown right? Since my teenage years I always feared going back into therapy. I feared that I could not handle it. I feared that I could not handle what would come out of the box. And I won't lie to you therapy is very difficult and you go through a lot of painful things. But it's the best thing I could have ever done for myself ,ever. I feel much better than I have ever remembered feeling in my whole life. I have 1 million times more coping skills than I used to have. All of my relationships now are 1 million times better. My whole life is just better.

 

I would say go ahead and give it a shot! The way I see it if you're at the bottom you have nothing more to lose. The only way to go from there is up.

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I have the date and time of the local ACoA meeting written down. I am going to email the contact person for that and go Sunday. I am going to make my mind up and go. I know that hearing other peoples' stories and sharing mine in a group setting will help me, I'm just feeling anxious about doing that.

 

I'd also like to go to OA....so, I will post back what happens.

 

Thanks for the support. There are things I don't feel I can share with my real life friends yet, and I love coming to ENA for support and guidance.

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I've been to both psychologists and LCSW's, and to be honest, I've preferred the latter. For some reason, I find social workers to be more down-to-earth, less "ivory tower". I think the emphasis in the training with social work might be a better fit for you, as they deal with family systems and do a ton of field work, whereas psychologists can be somewhat more "academic"/theoretical. I don't profess to know all the differences in background, but I've felt social workers to be more "real".

 

But it always comes down to the individual therapist, and I've had a couple of good psychologists, too.

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  • 2 weeks later...

Thank you for the replies. I find that therapy with a psychologist was VERY different from the social worker. Therapy with the social worker feels like lunch with a close friend, where we are having a conversation about life. Except instead of being a close friend who has my back and might give advice based on my best interest, the social worker has nothing to gain and no reason to lead me in one direction or another.

 

The therapy with the psycholoist felt much....deeper. Because she charges so much and I havent' met my deductible, I got down to the nitty gritty right away so we can begin the hard work sooner rather than later. I told her about my sexual abuse, date rape, my Mom being mentally ill and a recovered alcoholic.....she mostly let me talk, then would guide me a little based on things I said. But I spent close to the hour talking.

 

I feel like I need both right now, so plan to continue with both.

 

I went to my first ACoA meeting yesterday! I have every reason NOT to go...fear of the unknown, of letting outsiders in, it's early (8:30) and I like sleeping in on weekends (I work M-F), it's 20 miles away (there are none closer to me, they aren't as vast as AA or Alanon or OA...) I have EVERY intention of going weekly as much as possible.

 

I have the time and place of the local Monday evening OA meeting in my cell phone and plan to go tonight at 7. There is also a local one Wednesday evenings, and one Sunday afternoon at either 12 or 12:30.

 

I had to be in court today for my volunteer work....the attorney actually called me to testify, that was scary. I am at work now until 4:30, then I have therapy with the psychologist at 5. I may not have anything emotionally left by 7. But I do plan to go.

 

Thank you all for your feedback.

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I'm not really digging my psychologist. The first thing was, she never told me she expected payment up front. I understand she has to earn a living, but we spoke on the phone before my first appointment. She did say she checked into my deductible and that I haven't met it yet, but she never said "I charge $170 and expect payment at each session."

 

So after the first session she said "Your deductible is $750, you've met $3XX.XX towards your deductible, my fee is $170.00." Then she smiled at me sweetly. I looked at her like, yeah, ok? And she said "I accept check...." and I said "Oh, I pay you today?" She said yes. I explained to her that although she charges $170, my insurance will tell her the "Amount Allowed" which will be less. She said I haven't met my deductible, I said that hasn't mattered, they will still write your amount down to whatever their allowed amount is. She still made me pay the $170.

 

Before telling me to pay her we had made another appointment for the following week (weekly appts). I said to her we better change that appt because I can't afford $170 weekly. She said she was willing to work with me and bill me for the rest, what was I willing to pay? I said $50 (but even that's too much).

 

So second session was yesterday. I get to a pivotal part, and she says "Let's pause there." I look at my watch, then her clock. She stopped us at 50 minutes. AND AND AND, I had just said something significant. So you're going to bill me $170 for an hour, but only let me talk 50 minutes? I didn't say a word. Then I said "We agreed on $50, right?" She said yes, so I wrote out the check.

 

She said, sweet and innocent again "I will see you next week" (meaning Monday at the same time, 5:00 PM).

 

I looked at her and said "Let's make it two weeks (because of the $)".

 

She said "I'm concerned about the work." So I said, Ok, see you in a week.

 

This woman called me back after I submitted an internet request, like within 15-30 minutes of the request. She is pushing me to pay up front, which again, I understand, but I just moved out on my own and have to figure out how to budget and everything...and now she is making me feel like I ABSOLUTELY have to go weekly.

 

Plus she told me I need to stop seeing her or the LCSW because it's a conflict for me, I may start "splitting", which I can understand after she explained that.

 

I feel like I should cancel next week's appointment, keep seeing the LCSW for my remaining 4 free EAP sessions, and then maybe once I look at my finances, go back to the psychologist.

 

Thoughts? Advice? I do definitely feel the psychologist pushes me to dig deeper emotionally, and like I need it. But is it really going to hurt if I wait two months to see her again while I finish my free sessions with the LCSW?

 

Not to mention, as I already mentioned, I am going to ACoA meetings (well, one so far, but have EVERY intention of going as often as possible).

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I really don't know what to tell you because I've never seen more than one person at one time. Personally, if money's tight I would go with your 4 free sessions and then see her after. I understand too she has to make a living she went to school for a lot of years to become a psychologist. But personally I think it depends on the LSW. Mine asks very probing questions with me. And she challenges my belief systems about myself and other people all the time.

 

Is there anywhere that you can go that has a sliding scale?

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Yeah, she has her PhD and I totally get she has a lot of schooling. I know she needs to get paid (like you said). It's just that I'm just trying to learn to budget and make sure I can make ends meet right now. And like I said, when I said lets make the appt for 2 weeks and she said "I'm concerned about the work"....I really dont' feel suicidal or like my life is going to end or anything. I do need the therapy.

 

I like my LCSW, but she really doesn't dig deep enough. She lets me lead, and if I lead I kinda don't talk about things that are uncomfortable.

 

Maybe the whole thing is just a different dynamic? I know the LCSW right now is free, so I don't feel a need to get it all out there (she knows about my sexual abuse, but she doesn't push me to talk about it). Whereas with how much the PhD charges I push myself to talk about the deep issues so Im' not beating around the bush for weeks/months?

 

IDK

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Okay ,that's a mindset you have to get over. Free is just as important as paid for. You are doing this for yourself so whether it's free or paid both is equally important as the other. This is about YOU not the price tag. Right? All my counseling is free. But I treated as if it were gold. Because it is about ME. And I am precious. So start treating yourself as precious and every bit of help that you get just as precious. Because the other workers' time is free is no reason to treat it any less precious see what I mean? That is kind of like an insult to her and insult to you.

 

Yes ,initially the work is rather intensive which means that you go every week. But as you can learn to keep the ball rolling for yourself then it gets less intensive.

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You're absolutely right. Whether the therapy is free or not, I should be getting the most out of it. I just don't know how to push myself. When I think and talk about my sexual abuse I feel scared like a little girl again. Those feelings are so uncomfortable. Even typing this brings tears to my eyes. So I avoid that topic. And my counselor doesn't bring it up, in relation to anything.

 

I know my mom being mentally ill, an alcoholic when I was a child, and my sexual abuse/rape are the things I need to work on, but the sexual stuff carries so much shame with it.

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Actually, a "50-minute hour" is pretty typical. Most psychologists/psychiatrists do that, so they can write notes before the next patient. I've had therapists give me an hour or even more (if they were more laid back and/or if something was dire), but many stop ON THE DOT at 50 minutes. I've had that happen mid-tears streaming down my face. Feels pretty awful/embarrassing, but they have a schedule to keep. So keep your eye a little on the time (but the most important things seem to come up at the end, after you've warmed up, so pace yourself!)

 

I do understand her point about the 2 weeks in between being hard to keep momentum. True, you can pick up where you left off and you're not in crisis, but it rarely works out that you pick up where you left off, and it feels like you have to almost spend some time getting back into the flow if 2 weeks go by. At first, when you're doing more intensive work and lots of feelings come up fast, and the iron is hot, it can feel like a lot of time for half a month to go by before dealing with the subject again. I've had the experience that a lot of things in life come up in two weeks, which change how you feel, your mood, the picture in your life, and therefore, you're spending that time catching the therapist up on what's gone on since the last session rather than continuing where you left off and keeping the thread alive. So if she's willing to work with your budget, I'd try to go every week.

 

If you really can't, you really can't. But it's better when you're just getting started to keep the visits closer together so you have more continuity.

 

You said a couple of times how she "smiled sweetly" and I don't know if you're hinting that you feel she's insincere. You should be able to trust your therapist, that she's genuine, and genuinely cares about you. So if you feel that she's not being straight with you, that's not a good sign. There's not enough information in your posts to know that this is just your interpretation and being new to therapy, or something you're picking up from her that's a bit of a red flag.

 

The main thing is if she's helping you dig deeper and asking the right questions, she's probably a good therapist.

 

I've had psychologists that didn't help me dig deeper, and I've had a couple of social workers that were more "deep". So it kind of depends on the individual counselor. But overall, what you're describing about the informality of the social worker vs. the formality of the psychologist is pretty typical, from my experience.

 

Whoever you see though, it's not a good use of your time if you're not talking about the subjects you most need to, and so you have to be proactive. I find it uncomfortable telling them what is needed, but that's part of their job -- for you to give feedback about what you need. It may be that the social worker is going on the assumption that other topics will lead you to what's not comfortable, so perhaps you need to tell her point blank that you feel talking about the sexual abuse is important to you, but you need more guidance during the session for that to happen. Hopefully, she's competent enough to handle the topic once steering. But beating around the bush is not going to do you much good. I wouldn't say stop seeing her, but you should try to maximize the visits by telling her it's hard to talk about some things and you feel you need more input from her.

 

Finally, I've had overlapping therapists before and how that works out all depends on the patient personality, their issues, and the philosophy of the therapist. If you're new to therapy, and your particular psychological state would make you vulnerable to "splitting", it's a valid point of concern. But I've had therapists complement one another and it not been a conflict. If I had a therapist tell me I had to pick, I'd be a little wary about the therapist being too rigid, but it's quite possible that in your case, it would be appropriate.

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One other thing is, I don't know if you ONLY have 4 visits with the social worker, but it would not be good to open a can of worms or Pandora's box and then be left hanging. So be clear on your objectives. You can't get much accomplished in 4 sessions only. So it may not be good to start something you have to abruptly stop, mid-"surgery". Again, there needs to be continuity, until you're at some point of resolution (unless you don't want//need her services anymore). So consider what's going to happen after the 4 sessions.

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You said a couple of times how she "smiled sweetly" and I don't know if you're hinting that you feel she's insincere. You should be able to trust your therapist, that she's genuine, and genuinely cares about you. So if you feel that she's not being straight with you, that's not a good sign. There's not enough information in your posts to know that this is just your interpretation and being new to therapy, or something you're picking up from her that's a bit of a red flag.

 

I'm going to preface my reply with: I know this is the psychologists career, it is her bread and butter, it's how she pay her bills. I understand that fully.

 

However, with that said, I feel like her sole motivation is money, and yes I think that causes me a great deal of pause. Let me explain why I feel the way I do:

 

I submitted a referral through the internet to her. She called me back within 15-30 minutes. I asked myself "What psychologist has so much free time on her hands that she can call me back that quickly, I'm not even a patient yet." Ok, so that's red flag number one, but if there weren't other red flags, I would have disregarded that.

 

So we talk on the phone when she calls, she gets my insurance information, she then calls me back to tell me I have my deductible which has not been met. She DOES NOT say anything about paying for each session each week up front. I obvioulsy don't know this is a red flag until AFTER my first session. I feel that $170 is a lot of money, and she should be disclosing up front that she expects payment at the time of appointment. She does not even have a note stating this in her waiting area (I've seen this in other dentists and doctors office "Payment is due at time of service."

 

So, I have my first session. DURING this session, I tell her this is the first time on my own, that I've been afraid of being on my own because of money. I mention that I don't get child support. I told her I had JUST moved out of my mother's house a week prior. I said that I know with time things will be fine, I just have to learn to budget (and I DO know this in my heart). So I've brought up my concern about money during my session, having NO CLUE that she is going to ask me to pay her $170 at the end.

 

That's when she looks at me after the session and says "So, your deductible is $750, you're at $300+ (I don't remember the exact amount, only that it was at in the 300's.). My fee is $170 per session." She then pauses. I have no idea that she is expecting me to pay her until she started saying what payment methods she takes. So I then pull out my check book and write a check for $170. This is red flag number two.

 

Then, after paying her $170, I say "Let's push out next week's appointment a few weeks because I can't afford to pay $170 a week." She said "What can you afford to pay?" I said "Maybe $50?" So she says "Ok, let's keep next week's appointment, you can pay $50, and I will bill you for the rest, if that's OK with you."

 

This is now red flag number 3. I have told you during therapy that I am on my own, solely responsible for me and my son, I just gave you a check for $170, I asked to push out the next appointment, and it's ONLY THEN that you offer to accept less. She does not offer me the check for $170 back and tell me to pay $50 today, only that we will begin paying $50 the next week.

 

During this time I also expalined to her the way my insurance works. I said although you charge $170 my insurance company will tell you the Amount Allowed. They are going to drop that number way down. She said "Not when you havent' met your deductible." I said, "Yes, although I haven't met my deductible, they still will drop the amount down. I know this because I am seeing a chiropractor in this very building and she tried billing $200+ for two appointments (she used heat therapy at one of them so I think that drove the price up) and they dropped her billed amount below $100, and I was still working towards my deductible at that time. So this is another mild red flag.

 

So we have our second appointment, I don't like that she cut me off at a pivotal moment, but I understand as you explained she has a schedule to keep, and she uses that 10 minutes to take notes before her next appointment. But then she says "I'll see you next Monday at 5" and that's when I again said "Let's see each other in a few weeks." And she said "I'm afraid about the work."

 

So you addressed that as well, and I understand that, but I literally just moved out on my own. My primary responsibility is taking care of my son and I and making sure I can make this work financially. I really don't have the money for this.

 

I got 8 free sessions for the LCSW through my Employers "Employee Assistance Program" and I've used 4 sessions.

 

Since I know, after writing this all down, that I feel my psychologist is motivated more by money than by my well being (which again, I know she has to make a living), I am going to cancel my next appointment and discontinue seeing her. I am going to continue seeing the LCSW, and tell her that I feel I need to talk about my past, and that it's hard for me to talk about so sometimes I may need her to push me. I will, however, try to become as proactive as possible in that respect.

 

I began reading the Red Book of Adult Children of Alcoholics. Wow, let me tell you, I feel like 90% of that book was written about me. I feel if I can be more forthcoming with my LCSW, I attend ACoA meetings weekly whenever possible, and I continue therapy with the LCSW (I asked her, by the way at my last session, how much she charges, and it's $85, but then she acknowledged that my insurance will knock that down to the "Amount Allowed" whatever that is, and I will be billed the remaining amount until I reach my deductible).

 

I just really have to put money first right now, and I feel with reading the ACoA book, attending the meetings and seeing ther LCSW, I can make significant progress. If, once my deductible is met, I feel I still need someone beyond the LCSW, I can find a new psychologist.

 

What I want to avoid, is being medicated. I had considered going to my family doctor and having her put me on some antidepressants (I have been thoroughly against that since being hospitalized in my teens...I personally feel that in America we overmedicate people, and the medication would only be a band aid for my issues. Not to put down anyone who is on meds, honestly not my intent, I just don't want to take them for me).

 

Thank you for your input, and I think the fact that you said you had pause with a few of the things I said, allowed me to see that I really don't feel trusting of my psychologist. I knew I had pause, but didnt' realize the significance of it until I was replying to your post.

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So, I left a voicemail about canceling Moday. Did not say I wanted to reschedule, or ask her to call me back. She called me back 1.5 hours later and left me a voicemail, asking if I'd like to "reschedule or schedule something further out."

 

Funny, that's what I wanted to do to begin with, and you said you were "Concerned about the work." Now you are wiling to schedule something "further out."

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So, I left a voicemail about canceling Moday. Did not say I wanted to reschedule, or ask her to call me back. She called me back 1.5 hours later and left me a voicemail, asking if I'd like to "reschedule or schedule something further out."

 

Funny, that's what I wanted to do to begin with, and you said you were "Concerned about the work." Now you are wiling to schedule something "further out."

 

Well Hun she can't force you to attend councelling. If you've shown reluctance twice she's not going to chase you down. You are the one that should care the most about your mental health. We all hold the primary responsibility for our own health.

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I think you're doing the right thing.

 

The only thing that puzzles me is that usually, the whole point of a deductible is for you to meet that first. So if you haven't, a provider can't bill insurance and be reimbursed (even for "allowed amount" or as I've seen it, "eligible charges" or "billable amount"). So I'm not sure how your insurance is breaking with that general rule, but it might have been her impression that billing your insurance would mean she not get paid. So if I am taking the devil's advocate, I'd put myself in her position and think, "I can't go on what the patient is saying about how other providers are being reimbursed (that's just your word/heresay), all I know is that if I see this patient every week for a value of $170 and insurance tells ME that they can't reimburse ME, I'll be way out of luck." I've never been to a provider and told them, "this is the way other providers do it" and having no experience with it themselves, they just trusted me and took my word for it as a patient. If this is a regular practice with your insurance company, it might be worth having some statement in writing from them about their policy to educate providers like this therapist, because I myself am wondering how you are able to use your insurance without the deductible being paid.

 

Aside from that, though, I think the biggest red flag was her saying, "I'm concerned about the work." And I'm almost getting that you feel that way, too. Because it seems patronizing at very least, and out of touch as well, since "the work" is your life, and your life involves being financially strapped. This is my #1 dislike about psychologists, as I mentioned: they can be lofty at the expense of dire practicalities. Social workers are trained to work with social handicaps, like low income and in-need situations more, so I find them more "real" in general. That's not to write off all psychologists though -- I've worked with a number of them that were both genuine and very upfront/helpful on practical issues.

 

I think your plan sounds good. Hopefully the social worker will step up to the plate, and it's good you're going to level with her.

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I have a health savings account. My company increased my deductible from 500 to 750 but they give me 250 annually in a health savings. I had leftover money from last year as well. I'm sure the way they do it is a tax benefit to them.

 

In all honesty I've exhausted those funds. But my insurance is still going to tell her the amount allowed, and then she should bill me for that amount.

 

I just wish she had been up front. If I knew I had to pay up front I would have told her I'll make an appt after I've had a few months to budget and save.

 

What's done is done, I can't change it and as I said I'm just venting. She just rubbed me the wrong way. I said in our first appt I was afraid of being on my own because of money, she tells me to pay 170, and only AFTER I say let's push the second appt out a few weeks does she THEN offer to let me pay less at the second appt.

 

My finances must come first. My mom is emotionally abusive and has been physically abusive, including spitting in my face. My boyfriend broke up with me so if I need money I'd have to ask my mom. Trust me, that's the LAST thing I wanna have to do. Doing weekly therapy to a tune of 170 a week will surely dig me in a hole I can't get out of.

 

Thanks for letting me vent and making my feelings feel justified.

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Maybe she was running on the assumption that if she told you that you've not met the deductible and were still willing to see her, you understood you'd be paying at that time. And she didn't know about how your particular insurance worked. So I think it was a combination of miscommunication on her part and possibly assuming that you knew you'd be paying out of pocket until the deductible was paid off, so she really didn't realize how dire it was for you until you said you had to space the visits apart (and she'd have to be an extraordinarily magnanimous person to hand you your check back). That would make some sense.

 

But it's still not an assumption she should be making, and yeah, she should have been upfront. She should have had a mutual explicit understanding before the appointment, and told you her rates at that time. And then that comment about being "concerned about the work" indicated she was not really listening to your predicament. I think she deserves to be fired for that, and you should definitely follow your intuition with therapists because you'll need to be trusting them for a long time to come with your vulnerabilities. Too bad you had someone like that so early in the game.

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Thank you for making me not feel like my expectations are unfair. As I said, I've been to other offices where there is a sign that says "Payment is due at time of service." And I can totally respect this is her career and how she pays her bills. I just wish I had been informed and educated on what she expected from me financially. And when I indicated money was an issue (on TWO occassions), she should have honored my request to push the next appointment (even the second appointment) out.

 

I am the adult child of an alcoholic. Part of my personality, which I need to work on, is I am a people pleaser and I don't know how to stick up for myself. That's why I couldn't stick to my guns when I said let's push the next appointment out more than a week. And I think as a psychologist she knew that.

 

To give you another example of this, and why I am kinda behind financially right now....I had my heart set on one apartment. It took the landlord two weeks to finally connect with me. That should have been a red flag..but anyway when we finally connected he told me he was raising the rent. Based on the condition of the apartment I felt the amount he wanted to charge was unfair. So I went on Craigslist and found other places. I went and saw one two days later. I loved it! I indicated to the landlord three times during the meeting that I was extremely interested. He said he had two other people coming to see it. He later called me and said he was giving it to me, to call him back when I was home and settled.

 

So I call him, and he starts spouting off that the prorated rent for May (beginning the next day) was $585, plus the security. I told him I was planning to move June 1st. He said to me he already took the ad down and canceled his two other appointments. Of course I didn't know how to stand up for myself and say I'm sorry for any misunderstanding but I can't begin renting until June 1st (it's what I budged for). I should have stuck to my guns and seen what he said, but instead I was afraid I would lose it and I loved it, so I met him the next day and gave him the check and took the keys. So now instead of having extra money in the bank, I have NO money in the bank.

 

I lose my voice in situations like that. I don't know how to stand up for myself. The other place I had found, the landlord asked me on the phone when we set up our appointment to meet when I was looking to move, and I said I can move as early as June 1st. This guy, the one I ended up renting from, never said "I"m wiling to give it to you but you need to begin renting tomorrow."

 

I completely know this is my fault, I need to find my voice. It's definitely something I need to work on.

 

Sorry for the long rant. I have a lot of emotional work/healing to do.

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