Pushing Back on a Pushy Therapist

Hi Amy,

So I have a question. It’s kind of about my kid, but it’s mostly about money and navigating therapy options, and how those intersect.

My 3.5 year old son is in speech therapy right now for some physiological/low tone issues. His issues are not developmental, so while they are covered by insurance he is not eligible for early intervention. 

We have insurance that is good but not great.We are essentially paying out-of-pocket for therapy sessions until our deductible is met, which will not be for a while. And finances are really, really tight now–I have a baby due in a few months and my husband is on the job market. While we live in a very expensive town, we get away with it because we rent a tiny apartment and we only have one car. 

My son needs a very specialized type of therapy and there is only one practitioner in our very large urban center. She seems to do great work with my son and he likes her. But I…don’t like her. I mean, on a personal level she just rubs me the wrong way, and she doesn’t seem to “get” that affording her is a luxury for us that is difficult to sustain. 

The therapist practices in a very expensive area, and I think she is not used to dealing with people who are financially struggling. She is insisting that my son come to treatment every week, when it costs a lot of money, and necessitates me taking at least two hours off work at a time while I’m trying to bank PTO for my maternity leave. I’m already taking off time every two weeks to visit my OB, plus a chiropractor and various other appointments that come up (again, I’m the only one in the family with a car).

When I expressed to her that this was straining our finances and it was really hard for us to get there every week, her response was, “well, this is important.” She’s also made other “helpful” suggestions to us regarding our lives that were completely out of touch with our reality.

My husband and I are completely dedicated to our son and his program, but going to see her every week is a serious strain on us right now. My question is, how hard can I push back here? Do I just have to suck it up and stick with this therapist’s plan, even though it’s tough for our family, both financially and logistically? I am willing to go every other week but I don’t feel like I’m being heard or respected when I try to negotiate. Is this something that I am even allowed to do? I don’t want to jeopardize my son’s treatment but I want to keep my life somewhat manageable at least.

Thanks.

Ohhhhhh, this is such a tough situation. We’ve also encountered therapists and various practitioners like this — I’m thinking of one in particular who, despite probably helping my son in some ways, rubbed me the wrong way so strongly that I view our entire time with her as a giant, annoying waste of time and view her as someone we should have moved on from sooner. She, interestingly enough, was also someone we saw through our private insurance rather than Early Intervention (EI) or the school district, and was also pushy and oblivious to what a huge inconvenience the visits were for our family.

(My rant: She lived in a not-super-great area with horrible traffic but had zero patience for anyone who dared to get stuck in it. Her office had no waiting room so I’d spend the time sitting outside in the car with my two other boys, letting them watch a DVD. It was boring and wasted gas but there was nothing nearby to do and Lord knows I wasn’t going to risk driving a bit too far away and hitting more rush hour traffic on the way back. She wanted regular meetings with both my husband and I but wouldn’t allow us to bring any of the kids, even our youngest who was only in school for barely two hours a day, aka my most important work hours. She messed up insurance billing all the time and sent us bills she claimed were overdue, and she waited an inexplicably long time to make an important referral that ended up being what our son REALLY needed, rather than months of visits with her.)

Yes, the doctors and therapists are experts at what they do, but YOU are an important expert too:  You’re the expert on your child.

It’s hard to talk about all this stuff sometimes, lest you dare come across as being anything other than the perfect selfless special-needs parent. OF COURSE I will do whatever it takes to help my child. OF COURSE I will sacrifice time and money and get him the resources he needs. But it’s okay to admit that you need some balance and compromise somewhere between all that sacrificing (especially once you add younger siblings to the mix!). It’s also important to think independently and critically about the recommendations and opinions being hurled at you, and to make sure you’re not getting pushed into something merely because you’re scared or feel in over your head. Yes, the doctors and therapists are experts at what they do, but YOU are an important expert too:  You’re the expert on your child.

I’m curious, by the way, who told you that your son isn’t eligible for early intervention, simply because his needs aren’t “developmental.” Is his speech delayed, or otherwise abnormal and not where he should be? Are his needs anything that would be considered a disability of some kind, either physical or mental? Something resulting from your pregnancy or his birth or an illness? Because that’s all still in EI’s wheelhouse. Did he at least go through the EI evaluation process before free services were ruled out? And even if he DID, now that he’s 3.5 years old, have you reached out to the school district to have him re-evaluated? (Children typically transition out of EI at age three, and the school district takes over providing any necessary services.)  Obviously I don’t know the exact nature of his needs, but “physiological issues/low tone” were definitely terms and diagnoses I came across in our time in EI and our district’s PEP (Preschool Education Program). That might be your best shot at a second opinion and some financial relief.

If that’s still definitely not an option, then yeah, it’s time for a real heart to heart with the therapist. Tell her coming in every week is no longer going to be feasible for you, logistically or financially, and you need to amend your son’s treatment plan. Use declarative sentences and not questions for that part, so she knows it’s not something she can brush off again or push back with fear-based predictions of doom. What are some at-home exercises or activities you can do on the off week? If she really, deeply believes that dropping back to every other week would be Bad and Wrong, ask her straight-up for a discount or payment plan of some kind, at least until you hit your deductible. (Or your husband finds a job and/or you guys can start contributing to a Flex/Health Savings Account for this stuff.)

I assume, of course, that you’ve already done your due diligence and independent research on this very specialized therapy, but I’d suggest hitting the Internet before you have the talk and (hopefully) can find evidence/anecdotal data of kids and families who went less frequently and still achieved the desired results. We typically started our son’s speech/occupational therapies on a more “aggressive” weekly schedule, then dropped down to every other week or even monthly. I doubt you’re asking for anything crazy out of the ordinary here.

If nothing you say works and she remains insistent that every week is the way it HAS to be: I’d probably suck it up and personally continue going…while also REALLY shopping around for a second opinion on whether 1) this very specialized therapy really is the be-all, end-all recommendation for your son’s needs and not just the favorite course of action of whoever made the referral, and 2) there really isn’t any other speech therapist in your area who — despite maybe not specializing in it 100% — is familiar enough with it to take over your son’s case. Having a therapist who is a “good fit” is incredibly important, and I think that “fit” needs to extend beyond just your child, but to your whole family and overall quality of life. Good luck!

Photo source: Depositphotos/belchonock

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