Money Matters: The Fee in Psychotherapy and Psychoanalysis

It has been almost 80 years since Freud wrote these lines, yet money is still a disturbing topic. Therapists are often as uncomfortable as their clients are with 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 are 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, examples of questions that commonly cause discomfort for therapists are presented.
The third section, on therapist attitudes, covers the actual role of the professional, the advantages and disadvantages of different fee policies, and how to discuss fee policies at the beginning of the therapeutic relationship. The final section describes fee arrangements that have been shown to be effective for various therapist-patient relationships. With a particular focus on funding mental health services, these chapters also discuss new and alternative approaches such as graduated copayments based on income level and increasing payment options for both consumers and providers.
Providing the "matter of course frankness" that Freud called for, this book will be welcomed by all those who earn their living as professional therapists.