Therapy and Money

Wednesday, March 16th, 2011, Written by jackrosenberger

Now this is a topic that usually gets A LOT of attention.  My approach is pretty simple.  Many times I envy my British colleagues; the government simply gives them a living wage for the year and basically says, “Take care of as many of your fellow citizens as you can.”

I wish I had that arrangement.

Unfortunately, I have to do things like billing and that is clearly NOT where my talent lies. My affection, regard and love for my patients are free.  But the basic needs of living – rent,  food and Bucke’s kibble – are not.  So what’s to be done?  The need is so great I could work 24 hours a day and still not make a dent. I’d burn myself out and ultimately be no good to anyone. Plus people are sometimes resistant to analytic therapy, and the process could become a mess that no analyst could untangle.

Why must people pay for therapy?

Paying for these services is standard and certainly beneficial to both the therapist and the patient.  Why?  A number of reasons:

  1. The therapist brings an objectivity to the encounter that NO friend or family member can. Sometimes that objectivity allows the analyst to say things that appear tough but are actually necessary.
  2. The therapist brings training and experience to the encounter.  This affords the patient greater expertise in how to deal with the issues that he/she is working on.
  3. The therapist also brings a focus on the patient that is unique.  Think about it:  how many times in a day does someone pay attention to you and only you for an hour, thinking only of ways to help move you from one place you don’t like to another you’d like more?  In this distracted society, that does not appear to happen too frequently.
  4. The therapist is available 24/7 – especially at SPARK.  Most people don’t want to “disturb” their friends and family at 3:00 a m.  But that is what the therapist is there for!
  5. The clinician should have no other agenda in the helping relationship.  There should be no thought of “if I do this for this patient, what can I expect from him/her?” I emphasize “should” because, unfortunately, some do not.

This kind of thinking leads to boundary violations and injuries to the self.  In this way, the fee requested for therapy allows the patient to know what should be the only “selfish” concern of the analyst.  The fee helps set a boundary that should help everyone feel safe,  or at least safer.  Once the payment of the fee breaks down, unless the analyst has excellent boundaries, the door is open to all kinds of trouble. And its usually of the sort that leaves permanent psychological scars

Finally, the old saying “that which comes too easily we esteem too lightly” appears to be true.  Every clinical study has shown that people who pay for therapy get better while those who get it with no cost tend to either stay stuck or get worse!  In this way, the little bit of “skin in the game” that therapists asks for is not that much in comparison to what the analytic relationship has to offer.

At SPARK we attempt to make therapy as affordable as possible.  But all too often, I have had patients attempt to manipulate a “bargain” or simply default on their obligation.  This can only make one wonder about that patient’s boundaries.  And if they are parents, as some would say, Oy gevalt!  (It’s Yiddish….Google it.)

One final example

If one had (Ha Shem forbid) cancer, one would not argue with the oncologist about the rads of radiation therapy.  Hopefully, one would trust that doctor’s experience, training, and wisdom.  The same holds true for psychotherapy.  As I have always said, psychotherapy is a relationship. Like all relationships, it is built on trust.  With no trust, there can be no relationship, and thus no true healing of body, mind, and soul.  And wouldn’t that be the point of going to therapy in the first place??

At the end of the day, it’s been my experience that everyone that goes to work expects to get paid a competitive wage for their work.  That seems fair.

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