A Bit More On Cost

So here I am with a client who has been unemployed for about 4 months now, is three months behind on the mortgage payments, and is awaiting the "call" from the previous employer who has promised a job "next week" for a couple of months now (there is a huge bureaucracy involved, so this sort of delay is not surprising). Therapy is truly helping this person. It's not a "brief" therapy. This could go on for quite a while. By now I'm carrying a back bill of 6 sessions. Not tremendous, and not nothing either. This affects my income, which, in case you wonder, is not large. I enjoy working with this client, not least because I see the steady progress that is being made in some pretty significant areas, and because of the commitment that this client has made to healing.

I'm willing to "carry" this client. I expect to be paid some day, but who knows? In spite of today's headlines that declare that the recession is officially over, this client is caught up in the same financial circumstances that literally millions of other Americans face: the highest unemployment rates in decades; unprecedented home foreclosure rates; a general economy that, before today it seems, has been shrinking. Yesterday, when a check was offered at session's end, after we had talked about the relationship between client's shame and the lack of money, I gave it back and told this client to go buy food instead.

I'm not telling this story to garner praise for my generosity. To me this situation seems obvious and inevitable: one does not take money for therapy when one knows that the client has had to borrow money for food, and when there is an established therapeutic relationship in place that is benefiting the client.

When people I feel a connection with ask me about my work, my stock answer is that it's a good thing that my wife has a real job. We certainly wouldn't be able to live on what I make. And partly, this is because of personal decisions I've made regarding my fees, my non-relationship with insurance companies, and situations like the one described above. Also, I'm not a very good "business" person, not unlike many creative people, so "marketing" isn't something I do. Oh well. C'est la vie.

I know there are "high powered" therapists who make huge incomes because they are good business people, because they approach their private practices as businesses first, and, not insignificantly, because they see largely wealthy clients. This has never been my approach, or my motivation for practicing as a therapist. It's not where I come from, either personally or professionally. So what about every one else? The "average" person, or the poor person needing therapy? A client at a private, expensive residential treatment facility that I used to work at once said, in expressing his gratitude for his situation, that while he was fortunate to be able to pay for his treatment, "poor addicts just die". And so it goes.

Or does it have to?







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