I have been in and out of therapy for years. I’ve really been trying to stick to it. A few months ago I was feeling suicidal and I was self-harming. Things I really hadn’t felt for at least 15 years. I reached out to my T and called said I was really having a hard time. I just left a phone message. Anyway she never called me back. I really felt hurt and she pretty much confirmed my feelings that therapists are people just doing a job and don’t really care about you. I’m so intimidated by her that I have anxiety attacks before I go to appointment. I have a really hard time trusting and believing in people. I really do want help. But I can never get in for appointments and I feel like I have a lot to work out. So then I start my self doubting that they Therapists think I don’t need help that bad and my problems aren’t that bad. I really don’t know how to make therapy work better for me or how to trust the system. I feel like I should be in some sort of mental health rehab. I’m sure Id lose my job and insurance wouldn’t pay for it anyway. I don’t want to start all over again. I just want someone to help me.

A: I am sorry your therapist did not call you back, and that you are having so much anxiety about the appointments. However, I think this is an opportunity for you to work through this situation. I have three thoughts.

First, I would tell the therapist you were upset by her not returning the call. Do not let this go without speaking up about it. The therapist needs to know your expectation and explain her part of the equation. If she says that it is not her policy to return calls this would need to be discussed and clarified. Both of you need to have a clear expectation of responsibility to each other. Don’t let this be a gray area. It is very healthy for the two of you to work out what is needed. If the therapist says she doesn’t return calls you will have to decide if this is acceptable. If she says she only returns calls under certain conditions, both of you need to be clear what those conditions are.

Secondly I would tell he about your apprehension and intimidation over the meetings. This will be grist for the mill of therapy. You need to say it; she needs to hear it.

Finally I would ask for a standing appointment. See if a time could be worked out between the two of you that would be mutually acceptable. This should help reduce the anxiety, even if the sessions were spread apart. The regularity should be helpful.

Each of these suggestions has to do with clarifying the therapeutic relationship with regard to your expectations. My guess is that expectations in your intimate relationships will be important sources of reflection in your therapy.

Wishing you patience and peace,
Dr. Dan