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It sounds like you and your therapist really need to discuss why she doesn't want to write the letter, and you should certainly tell her about the anxiety it's caused. I'm sure it's not because you're fucking up.
Make your GYN and massage appointments. Don't let that scale get in your way of taking care of yourself (in every way). It doesn't know a thing about you, how hard you worked last semester, and how amazingly sucessful you were despite a lot of tough situations.