Serious Money: Understanding the therapist's place in the counting house

One of Freud’s more astute observations and one I never tire of quoting is that humanity has two needs towering above all else: Love and Money. A simplification maybe, but also a pithy truth. While not at first seeming connected, money and love frequently are intertwined. Not only in relation to the specific meaning of these two nouns when positioned inside of the psycho-therapeutic relationship but also within every intimate relationship. Marriage, in all societies, has traditionally been associated with the dowry. Even today there is often a marriage-broking backstory to many a romance. There are even apps analyzing the statistical costs of having one or more children in which the economy of childbirth could not seem more divorced from the ideal, or myth of unconditional love.

Money is a difficult topic both to discuss and to be honest about. The archetypal psychologist James Hillman unforgettably quipped that it is harder for a man to talk about what is in his pockets than behind his flies! While not wanting to harken back to some of Freud’s outmoded theories about the anal personality and the relationship between fecal matter and money there is no denying that talking about money can arouse feelings of shame and anxiety. Too little and you may be pitied; too much and there is the fear of envy. Unlike Goldilocks and her porridge, the balance never seems quite right. The relationship between love and money is querulous, whereas greed and money tend to waltz hand in hand.

The challenging relationship between matters of love and money inevitably feels uncomfortable when situated between the therapeutic couple in the consulting room where, at both symbolic and literal levels, so much of the dialogue revolves around "love." Its presence and absence throughout any individual’s life and the sufferings that are contained in its wake. The playwright Sophocles summed up human longing in one sentence:
'One word frees us of all the weight and pain of life. That word is love.'

The delicate structure of the therapeutic couple is not helped either by the transactional comparisons—made so often they amount to cliché—of therapist to prostitute.

Sometimes, a patient will comment, accompanied by a sigh, “This is the only place where I am really listened to and get my emotional needs met. But I have to pay for it.” At their most skeptical a patient can rubbish the therapist by insisting that the result of a financial transaction permits them to use their therapist as a dumping ground. In such instances it may be worth the therapist's remembering that gold is always found buried deep underground!

Obstinate thoughts about this co-habitation persist for both patient and therapist. In what is possibly the most intimate, emotionally vulnerable, professional relationship that exists—a relationship where the therapists earns their living, not like other members of the caring professions by curing acute disease and trauma, but only by listening and hoping over extended time and increasing trust to heal chronic unhappiness. While there are many psychological therapies like CBT and EMDR which offer time-limited treatments, the application of psychodynamic therapy can become more like taking out a mortgage when nobody knows the completion date.

Emotional disturbance and psychological illness are often exacerbated, if not caused by the absence of experiences of consistent containment in infancy and an experience of being unconditionally loved. How does one deconstruct the experience of unconditional love? A comprehensive analysis is not in the remit of this blog post but depends on the emotional maturity of the parents to survive inevitable attacks on their "power" without retaliation or withdrawal of their love. When people ask what emotional deposits create the golden matrix of self-esteem, I see these experiences as vital ingredients.

It is an unpalatable truth that the more crises and misfortunes that occur, the busier the therapist becomes. In these COVID times the demand for therapy, especially adolescent and children’s treatments, is higher than ever. While most patients are able to make a distinction between a concealed and often shameful desire to be loved unconditionally and their rational awareness that the therapist has to earn a living, the payment of a fee is a critical if painful reminder of the contractual nature of their relationship. When push comes to shove, the relationship is choreographed by strict ethics which are an attempt to protect the patient from all forms of abuse, including the inappropriate manipulation of the financial contract, which is there to remind both parties that the intimacy of the successful therapeutic relationship is also based on contracts of time and money.

Another frequent complaint used both to attack therapy and expressed as a concern by the patient is the question: “Why on earth would I want to pay someone to listen to my life unhappiness when I have friends?” Another anxiety being: “This must all be so boring to listen to, surely you can only be doing it for the money?” Any attempts at comprehensive answers relating to technique, again, do not fall within the scope of this blog but would need to include the prima facie assertion that the therapist is trained and paid to listen. As a result, therapists listen differently to family and friends, who are often more interested in trying to help and problem-solve and are not trained to understand unconscious motivations.

The unconscious is a genius at concealment, but there are clues that the skilled listening of the therapist has been trained to decipher. Marcel Proust writes:
'Each past day remains deposited within us as in some vast library where there are copies even of the oldest books, which probably no-one will ask to consult.'

The therapist’s skill is to uncover these lost narratives or "oldest of books" of self. It is also dependent on the therapist’s skill to help patients to understand the unique value of their paid contribution; to believe that their enhanced well-being is worth the taking out of a small "mortgage." At the same time therapists need to feel convinced that they are worth the fees they charge, the exploration of which also requires a sequel blog post.

What do my patients pay me for? The question feels rather like the question the poet William Blake asks:
'What is it that women (and men) do most require?'

My answer is that the people who consult me require and pay for compassionate and active listening. They require me to remember and re-member them not through note-taking, but because they are both renting and receiving a place at the center of my consciousness that extends beyond the fifty-minute hour. Through trust, which requires time to mature, they will grow confident that my memory is not funded by a notebook but grows into a visceral reservoir which holds their genogram and narrative at the center of my "self."

Hilary Mantel and Jane Haynes in conversation Autumn 2009 (left) & BBC - Podcasts - Start the Week with Andrew Marr (right)



BUY MY EBOOK NOW @ £9.99

Vogue Magazine


BBC Radio Interview


Spectator