The Cost Of Therapy

Typically, psychotherapy is pretty expensive. This is because it has its roots in an aristocratic white social environment, and because it developed out of a western medical milieu where professional medical people held high status and commanded high fees. Nowadays, "psychotherapists" include medical doctors (psychiatrists), psychologists (PhD's, PsyD's, or EdD's), and Masters level practitioners including clinical social workers (MSW, LISW, LCSW, etc.), and clinical counselors (LPCC's, LCPC's, etc.).

The debate about the cost of therapy is never ending, and there does not seem to be any clear cut way of resolving the dilemma. I say" dilemma" because many people who would benefit from good therapy will never have the opportunity to do so because the cost of the service is out of their reach. This is no different in many cases from the costs of medical and health care in general in our current economic system and insurance/(obscenely) profit driven health care system.

So what to do? There are community "mental health" agencies that are supposed to pick up this slack, and make therapy (or more commonly, "counseling") available to the masses. The reality however is that these agencies are typically government funded, and we all know what happens to funding for all "non-essential" services as a general rule: it is, of course, drastically cut. This means that many of these community mental health agencies go out of business. The ones that remain spend most of their time and energy struggling to survive, to raise funds, to meet ever increasing paperwork demands, and to provide direct services to ever growing numbers of people. It is not uncommon, for example, for a therapist at such an agency to be expected to see 25-30 clients a week. Plus do all the paperwork involved. Plus attend meetings. This is not possible if it is also expected that the therapist will be able to remain healthy and to provide quality service.

Then there are the private practice therapists. If insurance is funding the service, it may also not be uncommon for a therapist to see 30 clients (or patients) a week. If insurance is not funding the service, this number is likely to be considerably lower. Still, we all know that there are millions of Americans who do not have health insurance, and so are left to fund therapy services out of pocket. This is where the high cost becomes problematic for many.

The dilemma is extended when you factor in the legitimate need of the therapist to be able to make a living. So what does "make a living" mean? Of course this is different for every person.
Is the British surgeon who makes a million dollars a year under the socialized health care system, and living very well, being deprived because she or he is not making the 2 million she would make in unregulated America? You see how this goes.

So it becomes a very personal moral, ethical, practical and spiritual consideration for each practitioner. How much do I charge for my services? What are my legitimate needs? What are the "customary and usual" fees in my community? Are these within my personally acceptable parameters? Are they too high? Too low?

To be continued......................





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It's Not Rocket Science

Not infrequently I hear myself saying this to clients: "It's not rocket science."

What I'm referring to are the concepts involved in understanding how the psyche generally works.

I'm not even talking about the subconscious, or the unconscious, collective or otherwise. I'm simply talking about the basic rules of the road that seem to apply to everyone. For example, when we're afraid of being judged, we often employ a defense strategy - a "mechanism" - that will keep us protected from feeling the painful feeling of being judged by another. We might decide, internally, and probably out of consciousness (ok, I AM talking about the unconscious) that we don't care what anyone thinks or says about us, and present to the world, to other people, an outward demeanor that looks carefree and confident.


If it's too difficult - embarrassing, shame inducing, contrary to our image of our self - to admit that we were not able to be truly present for an intimate when they really needed us to be, we might offer any number of "rationalizations" or justifications, or just plain excuses, rather than feel the depth of the anger or the betrayal or the pain that our intimate is experiencing.


These sorts of things are very common. We have all learned and invented personal versions of them, and other strategies, to protect ourselves from unwanted feelings or thoughts. It's this sort of thing that I refer to when I say "It's not rocket science". Coming to understand these common psychological behaviors isn't all that difficult. What becomes difficult is to learn to see how they operate within ourselves, to learn how to "bust" ourselves when we're doing them, and to learn new ways of seeing and behaving that will contribute to freeing us from our own self defeating ways of doing things in relationship with others and with ourselves.


It does indeed take time, and effort, to learn and to establish new habits, and more self supporting ways of being in the world.






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