The Psychology of Money

by Kellen Von Houser, M.A.

The attitudes of both therapists and clients concerning money affect the successful negotiation of the fee arrangement. Money holds meaning for patients and therapists alike. Freud observed more than 50 years ago that in our culture, money is an even bigger taboo than sex. Money often carries very negative connotations. Phrases such as “filthy rich” and “money grubbing” are common. Some therapists unconsciously feel that selling their services for a fee is akin to prostitution, the “selling” of a human relationship in exchange for money. The concepts of “selling out” or selling one’s soul for money are also prevalent in our culture. The belief that anything profitable could not also be moral or ethical is also quite common.

It is important for therapists to examine their own beliefs and attitudes about money. Why? Because the inability to handle fees competently can result in clinical and ethical problems in the therapeutic process. The primary obstacle to therapists handling fees appropriately with their clients is their own attitudes toward money itself.

Therapist Attitudes about Money

Many therapists believe that the ideas of healing and profit are incompatible. This is a curious belief, for no therapist would suggest that doctors who alleviate physical pain should not be paid for their services.

There is another common belief that mixing fee collection with therapy is unethical. Yet ethics codes require that the therapist address the issue clearly and understandably. This failure to address it directly often results in clinical and ethical problems during the therapeutic process. It also sets a very bad precedent. If the therapist is uncomfortable discussing something as transparent as fees, how can they be trusted to handle discussions about sex or death comfortably?

Uncertainty of the value of therapy may exhibit itself as a reluctance to request an appropriate fee for the services being provided. This ambivalence over the intrinsic value of therapy itself can be felt throughout the therapeutic process and can undermine its effectiveness. Yalom has stated that hope is one of the primary requirements of successful therapy. Hope requires that the patient believe in the competence of the therapist and the value of therapy. This is why it is crucial that therapists work through the process of examining their beliefs about therapy and its worth, so that their behavior in the matters of setting fees, managing their time, and providing services reflects an authentic belief in the value of the work being done.

A therapist’s inability to discuss fees with clients may result from their own feelings of inadequacy about handling their own personal finances. If a therapist is having a difficult time financially or is not as financially astute as they think they should be, they may be reluctant to handle the issue of fees with clients for fear that this perceived inadequacy will be exposed. This is especially true if the client is more financially well off than the therapist.

Guilt about being paid for providing therapy often results from the belief that caring and profit cannot co-exist. This guilt may prevent the therapist from getting paid what they are truly worth. Avoiding fee setting or collection may represent ways of repressing this guilt.

Anxiety may result from trying to set fees for a service rather than a product. Products are very concrete, tangible things and it is easy to establish their worth. Services are far more nebulous. If the therapists are not clear in their own minds about the worth of their work, the anxiety which results could impair their ability to set appropriate fees.

Some therapists also fear being seen as greedy, grandiose, or unprofessional if they set fees they feel are appropriate for the services they provide. This too may result from not clarifying in their own minds the value of the service they provide. It is important that therapists not only examine their opinions of their own behavior but their opinions about the behavior of other professionals. How does the therapist feel about other therapists who request an appropriate fee? How do they feel about other professionals such as doctors, attorneys, or even their hairdresser or barber when they set appropriate fees?

When therapists don’t set and collect fees themselves, they may identify with the patients and the two of them may merge together in fee avoidance. This creates an unholy alliance against the receptionist, or whoever is collecting the fees. This too compromises the integrity of the therapeutic alliance.

Therapists who are new to practice may have the belief that they should not request an appropriate fee because they are “learning from the patients”. Hopefully, we will always be learning from the patients. A therapist who stops learning stops being effective. It’s important to examine this belief that the therapy cannot be of benefit to both patient and therapist without one of them being hurt.

There is also a common view among therapists that money issues are somehow ignoble or base and confounds the therapeutic relationship. This feeling may originate with feelings of inadequacy by the therapist and guilt for charging the client for this perceived inadequacy. This view may also reflect the view of money and profit as being dirty or unethical.

The therapist’s financial needs affect his or her behavior with clients. This may result in pressure to minimize negative indications for therapy in order to secure a client who can pay higher fees. Therapists may hesitate to take on clients who require a reduced fee. Whether therapy is continued or terminated may also be affected by the client’s ability to pay higher fees. It’s important for therapists to be aware of these dynamics and open to exploring their thoughts and feelings regarding payment.

Client Attitudes about Money

Money has many meanings for clients as well. It can symbolize self esteem, esteem for others, power, worldliness, or acceptance. The metaphor and meaning that money has for clients must be taken into account when arranging fees for therapy. This is especially true for clients who have boundary problems in other areas, who tend to view themselves as victims, litigious clients, and those with a history of emotional entanglements around money issues. Any fee agreement, especially if it deters from the standard agreement, must be handled ethically, professionally and with clinical sensitivity regarding the client’s attitudes toward money.

Some clients may use money to keep people close to them in order to prevent separation and/or individuation. They may have another person take care of their finances or refuse to take financial responsibility in order to remain financially dependent. Some may avoid wealth and the independence associated with it for the same reason. They will actually sabotage any attempts to accumulate money.

Other clients are afraid of making mistakes with money to the point that they are unable to act at all. Others may use wealth to fulfill narcissistic needs for validation and security. Still others may use external references, like money, to determine their self-esteem. Wealth may symbolize worth in an effort to deny the envy they feel for other people or their own feelings of inadequacy. Examining a client’s attitudes toward money can be very therapeutic. Their relationship with money can shed light on their overall personality style and ways of interacting with the world. This relationship can be observed in the therapeutic setting and the financial interactions which occur there.

A client’s cultural background, generation or age, geographical location, family of origin values, and gender may all affect their beliefs about money. In couples therapy, the difference in attitudes toward money is even more apparent than in individual therapy. Clients who tend to be hoarders will have different beliefs about money than over spenders. It’s very important for the clinician to explore each client’s values and beliefs when establishing a fee arrangement.

Client Behavior regarding Fees

How clients handle the paying of fees can also have meaning. A client may express feelings of hostility, guilt, contempt, seduction, anxiety, or a perception of fragility in their refusal to pay fees or the manner in which they choose to pay the fees.

Nonpayment

Clients may withhold payment as an attempt to intensify the therapeutic bond, provoking the therapist to pursue them by holding onto something which belongs to the therapist. The nonpayment of fees or carrying of a balance may be a patient’s attempt to bind the clinician to them and ward off fears of either the resolution or termination of therapy. The patient may view the money being held as something which belongs to the therapist and it may become a transition object. The patient may also be attempting to determine the importance the therapist places on money. Nonpayment may also be a way of retaliating against the therapist or inciting the therapist to anger. When trying to explore resentful, entitled feelings in the nonpaying patient it might be useful for the clinician to reflect: Is this patient trying to provoke, reclaim, or hold on?

Advanced Payment

Clients may pay fees well in advance in order to fend off fantasized hostility. Advanced payment may also be an attempt to prevent abandonment. The patient may fear the therapist’s withdrawal of their services if the patient does or says the wrong thing and may pay in advance to lock the therapist into the relationship and calm fears of future abandonment and loss of the relationship. If the therapist is working with a much older client it may be an attempt to reassure the patient against death itself.

Excessive Payment

Offering to pay fees in excess to their income may be a patient’s attempt to control the relationship, to do therapy on “their terms” or to ameliorate guilt from another source through the therapist.

Gifts

Gifts may be an oblique payment for therapy in an attempt to ward off feelings of indebtedness by the patient.
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