Money Matters: The Fee in Psychotherapy and Psychoanalysis

"Money matters are treated by civilized people in the same way as sexual matters--with the same inconsistency, prudishness, and hypocrisy. The analyst is therefore determined from the first not to fall in with this attitude, but, in his dealings with his patients, to treat money matters with the same matter-of-course frankness to which he wishes to educate them in things relating to sexual life."--Sigmund Freud, "On the Beginning of Treatment" (1913)

It has been almost eighty years since Freud wrote these lines, yet, money is still a disturbing topic. Therapists are often as uncomfortable as their clients discussing the fee, and this reticence can undermine the therapeutic relationship. Increasingly, it is recognized that money plays a key role in therapy and that it is necessary to clear the air about this ancient taboo. Breaking the silence, this book illuminates the problems of fee guilt and fee avoidance and proposes solutions based on a clarified understanding of what is therapeutic for all involved parties.

Providing an overview of the issues, the book first examines the significance of the fee in the psychotherapeutic process and its paradoxical nature. The meaning of money and the philosophy of service for a fee is also discussed. Exploring patients' attitudes about the fee, chapters in the second section illustrate how it can operate as a barrier to entering or remaining in therapy. The relationship between the fee and changes in the patients' financial circumstances is discussed and examples of questions that commonly cause discomfort for therapists are presented.