Money and Therapy

Case example 1

Matthias Beier, M.Div.,Ph.D.

Assistant Professor of Pastoral Care & Counseling Director, Mental Health Counseling Program Christian Theological Seminary Indianapolis, IN June 4, 20102 11:00 am CTS Counseling Center Parlor
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21 yr. accounting student suffered from severe constipation.Brought into treatment by his parents, he hardly spoke a word. At the end of the first session, the father in the waiting room produced a 3page write-up about As constipation problem which several physician specialists said was not due to any physical problems. He constantly occupied the only toilet of the family house. A had a withholding character structure, which was related to shameissues. His parents paid for most of the treatment. 2x/week therapy led to a reduction of constipation by joining him in using foul language, talking about money, and eventually him contributing to his treatment after he landed a surprisingly good accounting job.
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Factors influencing the meaning of money in therapy

External,material and social reality:

In psycho-analysis one only achieves this result [of treating habitual constipation] if one deals with the patients money complex and induces them to bring it into consciousness with all its connections.
(Source: Freud, S. (1908). Character and Anal Erotism. SE IX 173)

Internal and interpersonal,psychological reality:

economic system and value system, incl. job availability, cost of money (interest); value or devaluing of ability or disability in the market socio-cultural structure, incl. exploitation and privilege based on social conventions or prejudice; family wealth or debt; assistance Education pleasure, control, love, will, envy, power, fear of success, recognition, value of self, being wanted, death, (co)dependency, anxiety etc.
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Matthias Beier PhD

You set the fee, not the front desk

The front desk gives those who call an estimated fee based on the necessarily incomplete financial information provided in an initial call. The intake session fee is based on the estimated fee. The therapist establishes the actual fee for ongoing therapy with the patient during the first session, based on discussion of income,assets, etc. Indicate to patients that the fee will regularly be reviewed if the financial situation changes. Aim to increase fees on a sliding scale at least once a year.
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Money: transference and countertransference

All money conversations have transference and countertransference meaning when brought up in therapy. When someone wants to pay a very low fee and you later find out they actually are making much more than would justify this low fee on a sliding scale, the money issue needs to be addressed or else the therapy will soon be over

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Common character-traits important characteraround issue of money in therapy (Freud)

Orderly Parsimonious Obstinate

Case Example 2

anal eroticism in childhood later sublimated:e.g., getting pleasure out of withholding instead of stool: money, etc.
(Source: Freud, S. (1908). Character and Anal Erotism. SE IX 167-176)
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Emotional issues around money in therapy

Love Aggression Self worth

Practical Suggestions

What is money symbolic for in a case? Explore what the emotional cost for the patient is by being in therapy
Too painful,anxiety-provoking? E.g., to face having wasted all these years until now Separation from others and separation anxiety? Guilt feelings?

Respecting a patients ability to pay for therapy is respect for the strengths of the patient
Do not offer or suggest to lower the fee if the patient doesnt ask for it Setting a fee too low can prevent patient from sharing esp. aggressive feelings towards therapist out of guilt; and can be therapists avoidance of patients aggression.

Do not play God or savior by pretending money is not an issue or taking a masochistic, rationalized stance.
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Matthias Beier PhD

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On not playing God around money in therapy

Practical Suggestions (cont.)

The justification for requiring this emotional coldness in the analyst is that it creates the most advantageous conditions for both parties:for the doctor a desirable protection for his own emotional life and for the patient the largest amount of help that we can give him to-day.A surgeon of earlier times took as his motto the words:Je le pansai, Dieu le gurit. [I dressed his wounds, God cured him.] 1 The analyst should be content with something similar. (Freud, S. (1912).Recommendations to Physicians Practising Psycho-Analysis.SE XII, 115. Physical poverty is not a spiritual ideal!
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If you have a sliding scale,reevaluate and adjust fees regularly. Beware of letting patients split the transference between you and an institution you are working for as a therapist.Analyze the splitting,as the transference is ultimately always toward the therapist directly! Be very clear and consistent from the beginning about your fee and scheduling policy. Sample fee and scheduling policy
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