The Place of Money in Therapy

by Jude Fay

As the recession bites, both therapists and their clients are needing to adapt to the changing financial climate. Therapists are encountering new issues in relation to their fee income. Many are having to become more flexible about their financial expectations, their hours, and even the way they work. It is an appropriate time to look at the place of money in our profession.

What does money mean to you? Prosperity? Power? Security? Freedom? Guilt? Responsibility? We all need it to pay the bills, and lack of money can cause untold hardship and suffering. And yet, the prospect of being fabulously wealthy does not necessarily conjure up the positive feelings that its lack might suggest it would. Think of the words we use for those who have achieved great financial wealth, for example, ‘Filthy Rich’. Or common sayings about having money, such as, “We may see the small value God has for riches by the people he gives them to” (Arbuthnot, 1733).

I spoke to a group of newly qualified breastfeeding consultants recently, and was interested to hear from them that they found it hard to deal with money issues with their clients. Some reported that once they had established a rapport with a mother, they found it hard to be firm on the subject of money, and some found themselves letting money issues go, rather than potentially jeopardising the relationship. I don’t think the phenomenon is confined to that particular profession. It seems that many helping professionals struggle with the tension between charging a fair fee for the service they provide, and sitting with the pain or problem that their clients are presenting.

Some two years ago, on holidays abroad, I had a small disagreement with a friend over how much was appropriate to tip in a restaurant. I was in favour of tipping in accordance with the recommendation of the travel books, she wanted to leave much more. The amount involved was tiny, and we compromised and moved on. However, despite my robust argument (and I can argue well!), my resistance to paying more than the going rate sat uneasily with me. What did it say about me that I was unwilling to pay a few extra euros to someone less well off than myself? The inner critic took flight, and within moments I was calling myself mean, tight-fisted, small- minded and any number of other hard-hitting and well-chosen judgments. It sat uneasily with me because I like to think of myself as generous. I don’t think I have ever had an argument over money with anyone. I have always paid my way, am quick to discharge my debts and willingly share what I have with those around me. Had I been fooling myself all those years?

One aspect of our disagreement related to our responsibility as comparatively wealthy tourists in a poor country. My friend was in favour of giving more than was expected of us, because we could. Her argument was that we had a responsibility to support those who were worse off than us. Our trip was costing more than many of the people we met would have earned in a year. My response to her was that we were already supporting them, by travelling there, and buying and paying for the services and products they offered. I judged her to be reacting to their poverty from the guilt of being well-off, and I reacted to her reaction by rejecting the obligation I heard her demanding of me. It left me wondering how much is enough? For the rest of the trip and on my return home, I was still with that question.

Before training as a psychotherapist I worked in and for the accountancy profession for many years, the members of which are, in general, supporters of business and entrepreneurship. It came as somewhat of a surprise to me that having spent almost thirty years in that profession, that I was ambivalent about money issues. As I reflected on the question prompted by the incident above, How Much is Enough and its relevance for my new profession started to come into focus. Many therapists I know have been affected in a negative way by the recession, with falling client numbers, downward pressure on fees, and increasing demands for flexibility as regards appointments and scheduling. Many feel the tension between empathising with the financial struggles of those they want to help and needing to earn a sufficient living themselves.

One core issue seems to revolve around the ethics of earning a living from the pain and suffering of others. Is it unethical to earn a profit from counselling and psychotherapy? I don’t think so. But I am aware as I write that, that I am uncomfortable not so much with my answer, as with a fear of being exposed in my answer, a fear of being judged by others as materialistic, greedy, and perhaps lacking spirituality. I have struggled for some weeks to write this piece for the same reason. I am clear about my views, but unsure of how they will be received!

It seems that there are two camps: the pro-money, pro-business camp and the pro-people, pro-planet, anti-money camp. Or, to put it another way, the bad guys and the good guys, the haves and the have-nots, the rich and the poor. There is some basis for this split. It’s reported that most of the world’s wealth is held by a small few. The inference being, that in having great wealth, the rich are depriving the poor of what is justly theirs. I don’t know if the rich are actively taking from the poor, but this is certainly a point of view that is often expressed, especially in the media. It seems that one cannot both be rich and at the same time be a good person. The question then arises where the line gets drawn, or going back to the earlier question, How Much is Enough?

I have begun to question how my attitudes and underlying paradigms in relation to money impact on my work as a psychotherapist. Clients bring us their views of the world, their experiences and their struggles, and we engage with them. As a client tells us of their difficulty in paying our fee, do we nod sympathetically and give them a discount, colluding with the inevitability of the times, and their powerlessness in the face of it? Or do we use the situation to find a broader view, an expanded vision for them and for us?

I am reminded of that wonderful piece of writing by Neville Symington in which he describes his work with “Poor Miss Mary”, (Symington 2007) and how he became a prisoner of Mary’s illusion about her own lack of capability. His question to himself as to why Mary couldn’t pay the same fee as his other clients, and his subsequent exploration of the question with her, gave rise to a paradigm shift that freed them both from the limiting beliefs in which they were tangled. As a result of their work together, Mary moved to a better paying job, ditched her parasitic boyfriend and paid the higher fee. Symington says, “She had been able to do this because she had first been freed from the patronising attitude of her analyst”.

In what way might I be buying into my clients’ financial stories and seeing them as less than capable? Might my readiness to accept that my clients can’t afford to pay, and my willingness to accommodate them, be holding them in their own illusion of their powerlessness?

In his book, The Voice of Knowledge (Ruiz 2004), Miguel Ruiz describes how each of us is creating our life story all the time; a story in which we play the lead role, drawing those in our lives into our script, and assigning them roles which may have little to do with how they see themselves, and everything to do with the part we want them to play in our stories. As therapists, we may want to believe that we can see past these roles to the truth of the person beyond. However, we know that we can only see our clients through our own lenses, shaped by our culture, our family, our schooling, our religion and our experiences.

I grew up with the sayings, “Blessed are the poor” and “It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God”. I never really gave them much thought until recently, when it occurred to me that I had internalised them to mean that “poor people (also sick people, old people and vulnerable people) are more valued than rich people.” I found I was trying to reconcile this value with my parents’ desire that I should be financially secure and have a good standard of living. One important way in which this contradiction has impacted my life (and hence my work) has been an exaggerated sense of responsibility for others, especially those who, like Neville Symington, I see as “Poor Mary”. I have had to find a way to balance my respect for my clients’ ability and resourcefulness, with my perception of their vulnerability and fragility. In looking for that balance, I have had to look at my own shadow, my need to be important or significant to others, and where I might be looking to my client and their problems to bolster my ego. Perhaps my reaction to my friend’s desire to pay more than the going rate for a tip was the beginning of trying to free myself from these old paradigms?

And there are many other issues which arise when I start to look at the place of money in my life and in my work. For example, I ask myself whether the lens through which I view my client is also coloured by my need to earn a living? In my desire to pay the bills, am I inclined to look for my client’s problems, rather than seeing their wellness? Is there room in my work for both? In my response to what they bring, do I focus on what I see is wrong, or on where their lives are working well? Do I appreciate their growth when I see it? Do I look for that growth? And what is the impact of that on the work? I cannot hope to answer these questions for myself or for you in this short piece, but in telling you of some of the questions that I have been asking myself about this issue, I hope that you may come to find some of your own, and the answers too.

Jude Fay MIAHIP practices in Naas and Celbridge, Co Kildare. She will run a workshop on therapists’ relationship with money. www.thisbusinessoftherapy.com

References

Arbuthnot, Dr. J. (1733). Miscellanies. Vol 2. London: Benjamin Motte. Ruiz, D. M. (2004). The Voice of Knowledge, A Practical Guide to Inner Peace. California: Amber Allen Publishing
Symington, N. (2007). Becoming a Person Through Psychoanalysis. London: Karnac