Is Your Therapist Only in It for the Money?

Buzz_Tweed

Don’t believe what you are about to read. Consider the source: a retired psychologist who is going to rationalize that counselors care about more than money.

THE CASE FOR THE AFFIRMATIVE: that good therapists are only or largely in their profession to make money.

  • First, let’s look at the evidence against us. We do take your currency. Often, however, not exactly yours, but the dollars of third-parties like insurance companies or government payers. A therapist in independent practice receives this compensation directly. A clinic employee’s salary comes from the owner, who keeps a portion for himself.
  • Second, we monitor the clock. A mental health professional is like a taxi cab driver, who starts the “empathy meter” when you enter the office and turns it off upon elapse of the predetermined time. There is a mercenary quality here, isn’t there? Indeed, “the oldest profession” operates on a similar model. To the good, the doctor does not walk the street in a revealing outfit.
  • Third, we set limits on your access to us when “off the clock.” We don’t hang out with you, permit friendship, or consider a sexual relationship. Indeed, most of us won’t even stay connected once treatment ends.

Looks like a strong case to me. How about the case for the defense?

THE CASE FOR THE NEGATIVE: that good therapists are NOT only or largely in their profession to make money.

  • Careful readers will notice I’ve qualified the terms of the debate. To be a good therapist (not in a moral sense, but as a matter of excellence) you cannot be predominantly concerned with the amount of cash you might squeeze out of your client, any more than you are preoccupied with her/his sexual attractiveness or ability to tell a joke. To do a superior job the psychologist must be experienced, study for his entire professional life, and bring a concentrated intensity to his work. Most important, he has to care. If he views the client as a cash cow, he will betray a lack of concern and lose focus in session. Inattention and indifference to your suffering shall be evident. Moreover, the therapist’s grudging presence can only cause ineffectiveness. Disinterested in his vocation, the counselor will himself suffer. Even assuming he continues to get referrals, poor performance is inevitable. Feedback attesting to one’s mediocrity is hard to bear. The hack might as well labor in an overheated factory at a job he hates. As someone who did this during a summer break from college, I know the difference between the dedication to healing I was privileged to do and the sweltering experience of a mindless job in a metal stamping factory.
  • Many other professions offer more lucrative possibilities. Without a flourishing clientele of wealthy people happy to part with upwards of $150 per shortened-hour, therapy rates are set by insurance companies. Some of these may limit the fee to the neighborhood of $50 (before expenses), depending on your professional credentials. Were money the therapist’s only concern, he could do far better teaching in a business school, working on Wall Street, or making a living in advertising.
  • Your therapist does numerous tasks without compensation. He responds to phone calls and email from prospective and current patients, manages his corporation, interacts with an office manager, goes to conferences, reads clinical books and journals, maintains notes and treatment plans, deals with emergencies, consults colleagues, markets his practice, and enrolls in professional education courses. A counselor contractually obligated to follow managed care guidelines must supply information to case managers about the client’s progress. Such “precertification of medical necessity” is demanded periodically over the course of the doctor/patient relationship.
  • I’ve previously explained why therapists won’t hang out with you. It is not because they are not paid to do so. The first of two pertinent essays is called Being Excluded From Your Therapist’s Life/ The second is How would a Friendship with your Therapist Work?

256px-Lazy_Person

  •  Much of the practitioner’s income covers his office expenses. These include rent, furniture, occasional remodeling, malpractice (liability) insurance, utilities (heat, air-conditioning, electricity, telephone), books and journals, continuing education, computer hardware and software, accounting services, and taxes. If you didn’t pay him he’d be operating a not-for-profit corporation with a large deficit. Obtaining another full-time job to support his family could not be escaped. Impoverished, fatigued martyrs are not ideal role models for their patients.
  • The work of being a therapist can be stressful. You are responsible for the well-being of those good people who count on you during a difficult period of life. Depending on the size of your case load and the extent of emotional damage from which your patients seek to recover, shrinking heads demands the best of your intellect, stability, sensitivity, and frank energy. The danger of “burn out” always exists. A healthy counselor replenishes himself both through the fulfillment of the work and his life outside the profession. Most who wish only to make a fast dollar will discover their goal is inimical to their own well-being.

I hope I have convinced you. I doubt that I’ve persuaded all of you. I am not saying those who take on this vocation are indifferent to the value of a dollar, so contemptuous of money and worldly comfort we enjoy shelter in a cardboard box after a long day on the cross. The job is fulfilling, but the greatest part of the satisfaction is not from filling our pockets. Ministering to the suffering is wonderfully rewarding if you do it for the right reasons and have the temperament to match. Should the accumulation of wealth be the primary goal, the job becomes your enemy. If you want such a misguided person as a shrink, look for a “professional” who flagellates himself or sleeps away the day instead.

I hope I do not sound arrogant when I say I earned the comfortable living I made. And, by the way, I write these posts for free, a price everyone can afford.

The truth is, however, a few therapists ARE too concerned with making money. Some have even mastered the art of appearing touched by the lives of others. They can “fool all of the people some of the time and some of the people all of the time, but … cannot fool all of the people all of the time.”* The public in general knows little about the arcane science of psychotherapy. Many who never before consulted a therapist lack knowledge of what might be required to produce a good treatment outcome. I dare say most of us put too much faith in our psychotherapeutic, medical, and legal professionals, not to mention our plumber. The world has become a place of specialists and no consumer is a jack of all trades, ready to make a precise evaluation of the glut of service providers he employs in a lifetime.

My advice? Research the subject of therapy and get counseling referrals from those you trust before you visit Shrinkland, soon to be the newest attraction at Disney World. Know about your practitioner’s experience and training. Evaluate him as he evaluates you. But if you choose to put all of us in a barrel labeled Greedy Self-Interest, you will be dismissing most of us and surely the best of us: sort of like throwing out the champagne with the cork.

*This quotation is attributed to Abraham Lincoln, but can’t be verified. An interesting story about “Lincoln’s” words can be found here: Abe Lincoln.

The first photo is called Buzz Tweed, a fictitious Congressman, created by Buzz Tweed. The second image is A Lazy Person. It is the work of “A Dazed Memory.” Both are sourced from Wikimedia Commons.

24 thoughts on “Is Your Therapist Only in It for the Money?

  1. If my therapist is in it for the money, he’s really bad at it! 🙂 I’ve been seeing him for over nine years, he’s had one (very modest) rate hike in all that time. And I’ve thought it through, based on what I know my insurance company pays him per session, minus his office rent, billing service etc, he’s making a decent comfortable living, but nothing extravagant. I am also acutely aware of the time he takes to read and return my emails and phone calls, not to mention the always constant, but ever changing pile of books on his table. I pay for his expertise and his time, but I cannot buy what really matters; his care, his compassion, and his empathy. The feelings between us are real, albeit asymmetrical (I do recognize that he is more important to me than I am to him) and he takes the responsibility of who he is to me very seriously. There is no way to purchase that, it is freely given. So I pay him so he can practice his vocation and still manage to have shelter and food, but will always owe him a debt of gratitude for his patience, care and forebearance. Thanks for laying this out in your always clear manner. It provided affirmation for how I already thought. ~AG

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  2. You’ve convinced me 😉 And you really made me smile with your use of the words ‘shrinking heads’ – whenever I come home from therapy my husband always asks ‘how was your head shrinking session’? Thank you for another excellent post 🙂

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    • drgeraldstein

      Thank you. When my kids were small they would sometimes ask how my work day had been when I came home at day’s end. On at least one occasion I told them I’d accidentally shrunken at least one head to the size of the title character at the end of Beetlejuice!

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  3. “Most important, he has to care.” Intellectually I know it…emotionally I still have doubts but your blogs help me accept it might be true. Meanwhile, I laughed aloud thinking of you as a streetwalker on the streets of Chicago wearing a revealing outfit. As well as the taxi driver and the empathy meter. Copied that paragraph to read to my (female) therapist on Monday. I know she’ll “get a kick” out of it. I’ve told her about your blog in the past. I think you are a most respected (and respectable) man. Have a good day.

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  4. I’ve been slightly bothered that in the time I’ve been seeing t she hasn’t put up her prices. (2 years marriage counselling/3years individual therapy). I did bring it up once at the end of a session and said I wouldn’t mind if she did put up her price. I think she said something like she starts new clients on the higher rate then leaves people where they are. I’m aware too that it is up to her what she charges. She has recently suggested I might benefit from EMDR which she is not trained in. I have been looking at EMDR therapists and most (not all) are charging nearly double what my t is. And I have asked my t if she might come with me to EMDR at first as my paid session with her. It worries me slightly the difference in the cost of the two! I find it slightly embarrassing somehow but not sure why. (Though I am British!) Thanks again for your post.

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    • drgeraldstein

      Thank you, Lorraine. While I certainly don’t know your therapist’s motives for not raising her fee, I can tell you that I’ve encountered some counselors for whom this is a real problem. It is easiest to establish a fee a stick with it from the start. Many new therapists find that they are uncomfortable asking people for money at all! If the counselor has confidence in himself and his work, raising a fee is a simple matter of being assertive. Unless money matters not at all to them, the question of refraining from raising a fee despite the passage of years may say something about the shrink’s own psychology.

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  5. drgeraldstein

    A friend has asked that I post the following comment anonymously. It provides an important and different perspective (from my post) on the question of therapists and money. The reader should understand that this man is describing the private psychiatric hospital system in the USA during the ’80s and ’90s. I will respond to his comment below.

    I will call him “Dr. Hoo:”

    In my career as a Psychologist, I found that perhaps most therapists were conscientious and dedicated. But there was a fairly sizable number of Psychologists,who had sociopathic characteristics. One of the most common “tricks of the trade” is to hire “sub-therapists” who work for say $30 per hour because they need the work, while the owner of the practice is billing $100 per hour to your insurance company. The owner may or may not pay much attention to the quality of treatment delivered by the sub-therapist. But they will sometimes sign the progress notes of a sub-therapist, who may not be licensed to do this. This took place a great deal during the 80s and 90s, I am not sure of the situation now. I myself was in the position of sub-therapist a few times in my career, working for someone who was billing a much higher fee than what I was receiving.

    I believe that I did a good job, but it was not because the owner of the practice paid any attention to the quality of my work, although he/she was very interested in the number of patients I could work into my schedule. . In such practices, some therapists are likely to receive good treatment, and others may very well receive mediocre treatment. Also it is worth saying that there is fine line between “mediocre” and “good.” What is mediocre for patient “x’ may in fact turn out great for patient “y”. I have heard numerous patients praise the work of Psychologists that I personally considered mediocre. But it isn’t really my opinion that matters, it was what occurred with the patient. On the other hand, I have seen Psychologists especially those working in hospitals who would carry 15 patients at one time, and bill up to $200 or thereabouts for 3 or 4 sessions a week, but only see each patient for five minutes. This is equally if not more true for some, but not all Psychiatrists. With hospitals as they are now, it is nothing for a Psychiatrist to bill $2,000 a week, and perhaps spend 20 minutes with the patient during the week. These are abuses that need to be corrected or they may damage the entire profession. (Although again some of the Psychologists and Psychiatrists that bill these exorbitant fees may be very good at “managing” a patient’s care by coordinating the treatment with milieu staff including social workers, nurses, and occupational therapists, and /or be very medication oriented, in which case he is also being reimbursed for carefully selecting and evaluating which psychiatric medications are appropriate. I consider that “fee abuse” in in-patient practice is a major problem. Insurance have intervened, in turn, by forcibly shortening the stay of the patient, a practice which helps neither patient nor practitioner.

    (I myself, along with a Psychiatrist I was working with, once hired just one sub-therapist who was highly qualified, fully licensed, etc. I had known her for several years. We also discussed in detail each case that she treated).

    I myself during my in-patient practice sometimes would sometimes only see the patient alone for 15-30 minutes instead of a full hour, but since I was very family therapy oriented, I would always schedule a one to one and a half hour family session every week that the patient was hospitalized, and afterward discharge where feasible..This is especially necessary in practices focusing on children and adolescents. There are some Psychologists who do not see the importance of family or marital sessions, or else perhaps are not trained in this. Social Workers may also fulfill this role. But the social worker role in in-patient therapy is highly ambiguous, with the focus often on other needs of the patient, relating to finances, living arrangements, and referrals, among other things. They do not have time for family therapy. So who is to do it?. Should it be a Psychologist? I don’t know. The are many cases especially in adult out-patient therapy where family therapy would not be indicated, or the patient may decide that he/she doesn’t want it even if it might be indicated.

    In some cases exists the sin of omission instead of commission. The therapist who continues to see a highly drug or alcohol dependent patient without working to refer the patient to focused group oriented treatment or residential center, is in my opinion, ignoring the patient’s most fundamental needs. If this is done in order to not lose a paying client, it is wrong. However, some patients are in denial and will not recognize their substance abuse issues, in or out of therapy.

    I once worked in a Clinic as a therapist for People Living (but mostly dying of AIDS), at first doing therapy to help prepare them for inevitable death, a task which I did not relish but this was in the days before effective medications were available. However, once I found out that these medications had become available in many areas, but were not available in the region I was working in, I stepped out of the role of “traditional psychologist” and encouraged my clients to meet each other and form a political action group to advocate for their rights to receive these new antirretroviral medications. Of course they had to agree to “come out” to other patients, and it was entirely their decision. But soon i found myself working in a group of 15-20 HIV/AIDS patients, who then began taking concrete action to obtain the drugs they needed to survive. In some Agencies I might have been fired for doing this, but luckily the Directors where I worked considered this to be a morally and professionally correct action on my part. But to me a Psychologist who does NOT consider taking such action in a similar situations (of which there are many) may be guilty of what I have referred to as a sin of omission. He/she just goes with the flow without seeing the larger picture at all, and this to me, is mediocre.

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    • drgeraldstein

      There are a great many issues raised by Dr. Hoo. I will limit myself to just those directly applicable to the question of the essay I wrote. First, the abuses described in the private psychiatric hospital system of 25 to 40 years ago have been altered by the much reduced lengths of stay at those hospitals. Second, those therapists who create large practices and hire “sub-therapists” are indeed responding to the profit motive and putting much time to generate business and manage the business. The licensure concerns described within the hospital setting of years ago, to the best of my knowledge, are largely absent from today’s outpatient therapy world. The “good therapists” I have described are giving patients the time for which they pay and nearly all of them do this. To do otherwise would be fraudulent. As a result, even inadequate counselors put in the time required in the typical outpatient setting. Although I did not so state, my essay was intended to focus on outpatient treatment alone. Little real therapy occurs within hospitals these days, the large majority of hospitalized patients spend only a few days to a few weeks there, with the goal of medical stabilization and as rapid a discharge as possible.

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  6. Yes they are in it for the money. All my therapist is interested in is buying multiple homes, buying the latest tech to show off and driving top of the range cars. It has left me very averse to greedy people.

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    • Sorry to hear of your experience with your counselor, Diane. You are wise to avoid greedy people. I may not be able to convince you that not all therapists are like this person, but it is true. I’ve known a handful of therapists like this person, but only a few. I do have a question for you, though. Why would someone go into a profession which requires them to spend so much time with people in distress while at the same time thinking only about how much money he can squeeze out of them to buy another house or fast car? In my teen years I did jobs only for the paycheck, deadly dull factory work in unsanitary conditions. Not worth it. Doing therapy only for the money sounds like a pretty grim way to use up one’s precious hours. Mostly those people who want to make enormous amounts of money find a different and more lucrative kind of work. Best of luck in getting over this very bad experience.

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  7. Yes, I have always wondered why therapists all seem to live in enormous houses and don’t appear to be able to drive anything other than a top-of-the-range Mercedes. I have wondered why they don’t choose to use their skills (in Britain anyway) working in the NHS and/or charities if they aren’t in it for the money as there are plenty of people who are in great need of therapy but who will never be able to afford private practice fees. Seems to me that those therapists still have work to do on their own narcissism and what sometimes feels like an overinflated sense of entitlement. I’ve often wondered what might still be driving an often poorly-disguised desperation for wealth and status despite years of analysis and training.

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    • We must know different people, Kitte. That said, I have known some who had corporations and employed other therapists, and they come closer to fitting your description. But, if you check the statistics, at least in the USA, most aren’t making a fortune. Thanks for your comment and best wishes.

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      • Thanks for your reply. Must be a London thing then as I’m talking individual private practice therapists not owners of corporations.

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      • I think that in any “high rent” district, we find people with lots of money, who charge high fees for whatever service they offer. I had a client who was an expert, talented hair stylist who, I’m sure, made a very fine living. That said, I doubt he represented all the stylists. But, you are right, we find narcissistic, status hungry people without too much trouble. By the way, this fellow was very down to earth and I always thought he deserved to be paid well.

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  8. Good luck to your client stylist – he’s obviously good at what he does. He deals in hair though, not emotional damage, empathy and psychological growth – hence my pondering on the question of why those skills aren’t more often used in the British NHS or charities if compassion and a wish to heal trauma/the effects of adverse childhoods is indeed more motivating to therapists than money. I was lucky as I found a good one which resulted in subsequent emotional wealth for me. As we’re both acknowledging though, there is a range of people and a range of motivations in being drawn to the profession and a minority do choose to work in public services to help people who couldn’t pay privately while others offer a few low-fee places privately. It’s just a shame that more don’t as it would improve access to therapy beyond the realm of those who are relatively well-off.

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  9. Unfortunately, I do think psychologists and psychiatrists are in it mainly or entirely for the money. I have a PhD myself, and I get paid a much lower hourly rate in my profession. I work much longer hours off-the-clock, and I also read journals to stay current in my field. I have seen many therapists, and they charge outlandish hourly rates. Plus, I have never had a therapist tell me about outside reading or research they have done regarding my case. My therapists contact me outside of the regular paid hours in a sparing and careful manner. They do not throw away their time. In addition, I have read one therapist complain that if she lowered her rates or gave a sliding pay scale, then she would have to work more hours! Imagine! More hours! I work a 60-80 hour work week myself, and I get a salary based on 40 hours of work. I see psychologists working less than 40 hours per week since I rarely see them offering evening or weekend hours. Face it. Psychologists just do not want to work very hard, and yet they like getting paid high rates. They are in their job for the money!

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    • drgeraldstein

      I’m sorry you’ve had the experiences with therapists you describe. As I’ve written in response to other comments, I wouldn’t take as broad an indictment of the profession based on my experience. That said, I think your experience and opinion is fair game for readers of this post to see and consider. Thanks for commenting.

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