[PeeJay]

I posted this in another thread, on fees. But I think it deserves its own thread.

Check this out. It is written by a therapist for other therapists.

I think the author makes good points. I agree with him on much of it and I think he was brave to speak up honestly about the fee and about insurance. I also think he comes across like an arrogant prick at times in the article.

The Cult of DSM

Excerpts:

My starting rate is $140 per hour. What exactly is it that justifies that rate? My masters and PhD degrees didn’t cost me anything like what a medical degree costs. My malpractice insurance is well under $500 a year. My equipment consists of a couple of chairs, a couch, a clock, and a box of Kleenex. What justifies my rate is the fact that the market will bear it, . . .

You’ve probably already worked out a method for determining a rate. You may use an income-based scale. Or maybe you state your fee and then ask a client how much he or she can afford to pay. A surprising number of people give an answer that seems fair. However, as I discovered when a man with a modest-paying job who’d negotiated a 40-percent reduction let it slip that a rich uncle had given him millions of dollars, you can get hosed. When this method fails—often because the client doesn’t know where to begin—I sometimes ask what kind of car he or she drives and what the payment is. Kia drivers pay less than BMW drivers. Or you can ask how much money they spend every week at happy hour.

I manage to average around $95 per hour. Many doctoral-level professionals make more money than that. But, on the other hand, most people make far less for doing work that’s much harder than sitting still and listening to unhappy people.

I once saw a woman who worked as an escort, the kind who charges men for the girlfriend experience. I challenged her choice of professions, and she responded by suggesting that our jobs weren’t all that different. Her hourly rate, she told me with some relish, was higher than mine (and speaking of sliding scales, when I discovered what her fee was, I raised mine to match it). The conversation forced the subject of money to the surface. It also gave us the chance to talk about the critical difference between us: that, among other things, she was paying me not to have sex with her. Most importantly, however, by bringing to light the disturbing fact that we were both in the business of renting out love, it forced us to pay attention to what exactly our relationship was about, why she had the need she did, and what she could do to make it possible to fulfill it without paying for the privilege.

What do you think?

[AmysJourney]

Originally Posted by PeeJay

I posted this in another thread, on fees. But I think it deserves its own thread.

Check this out. It is written by a therapist for other therapists.

I think the author makes good points. I agree with him on much of it and I think he was brave to speak up honestly about the fee and about insurance. I also think he comes across like an arrogant prick at times in the article.

The Cult of DSM

Excerpts:

My starting rate is $140 per hour. What exactly is it that justifies that rate? My masters and PhD degrees didn’t cost me anything like what a medical degree costs. My malpractice insurance is well under $500 a year. My equipment consists of a couple of chairs, a couch, a clock, and a box of Kleenex. What justifies my rate is the fact that the market will bear it, . . .

You’ve probably already worked out a method for determining a rate. You may use an income-based scale. Or maybe you state your fee and then ask a client how much he or she can afford to pay. A surprising number of people give an answer that seems fair. However, as I discovered when a man with a modest-paying job who’d negotiated a 40-percent reduction let it slip that a rich uncle had given him millions of dollars, you can get hosed. When this method fails—often because the client doesn’t know where to begin—I sometimes ask what kind of car he or she drives and what the payment is. Kia drivers pay less than BMW drivers. Or you can ask how much money they spend every week at happy hour.

I manage to average around $95 per hour. Many doctoral-level professionals make more money than that. But, on the other hand, most people make far less for doing work that’s much harder than sitting still and listening to unhappy people.

I once saw a woman who worked as an escort, the kind who charges men for the girlfriend experience. I challenged her choice of professions, and she responded by suggesting that our jobs weren’t all that different. Her hourly rate, she told me with some relish, was higher than mine (and speaking of sliding scales, when I discovered what her fee was, I raised mine to match it). The conversation forced the subject of money to the surface. It also gave us the chance to talk about the critical difference between us: that, among other things, she was paying me not to have sex with her. Most importantly, however, by bringing to light the disturbing fact that we were both in the business of renting out love, it forced us to pay attention to what exactly our relationship was about, why she had the need she did, and what she could do to make it possible to fulfill it without paying for the privilege.

What do you think?

I just read this article after I saw you link to it in another post! It's hilarious and it's interesting and frightening and condescending and intelligent - and you see I am mixing up a lot of positive and negative words here.
Your post headline was actually what struck me most in this article and I had the same idea to make this a thread!

Ok, so my opinion about "renting out love" - I think this therapist who wrote the article thinks a little too much of himself and what he does. And making a statement like this, comparing himself to an escort - it reverts the apparent intelligence into being an asshole who knows how to use words.. That's my opinion, haha..

[Cherubbs]

Funny, my T also refers to his job as an emotional hooker at times but he's joking.. I think. I guess it's a common comparison.

[stopdog]

I don't look to the therapist for love or affirmation. I don't even really understand how people find them supportive or feel they are on the client's side. I think there is some part of the comparison which fits the bill. It certainly comes up a lot.

I think there is a lot more truth to it than any of us would like to believe. It's kind of disgusting.

[Leah123]

I hired my therapist for her knowledge, experience, and skill in dealing with issues I needed to resolve. As we worked, we developed a caring relationship. My sense is that I pay for the former, and the latter is something sacred, beyond and complementary to the contracted work.

She says she'll be there for me as long as she is able, a lifelong commitment. She says if the time comes that I cannot afford her fee she will continue to see me, though I am 120% resolved not to allow that to happen. The guidance I pay for is a most worthwhile investment, has already paid huge dividends in my life and my family's life during the past year. The knowledge that she'd see me without the fee is very reassuring that the bond is genuine, and that she truly does she her work as a vocation, rather than a job.

I am sure many therapists fall somewhere on the spectrum between her and the person who wrote that article. I will withhold my opinion on him: I am trying to cut back on my cursing.

It is important though that therapists do help move the client toward a place of getting their needs met outside the session, in many cases gradually removing the need for therapy at all. But I trust all ethical therapists to do this, it's foundational to the practice. If we as clients aren't making any progress or don't trust that our therapist is ethical or that the expense is justifiable, certainly we would want to reevaluate. Obviously from the article, just having alphabet soup after your name doesn't guarantee fitness for a very special profession.

To many words to read. Sorry.

[Nightside of Eden]

This is one of the (many) reasons I refuse to ever consider therapy again. If the therapist actually cared about me, they wouldn't expect to be paid to spend time with me. The whole arrangement grosses me out, honestly. I have real friends who will listen to me for free. I don't need to hire someone to do that.

It's a blog and therefore one man's perspective. I suspect many other perspectives exist.

I do have to say this guy functions on a very low overhead. My T also pays a fee to the head of the group practice that covers rent, salaries of the secretarial employees, utilities, etc. Then there is the amount of his "pay" that he actually never sees because of agreements with various insurance companies. He lives a very modest life, drives a used car, doesn't even own his house.

The problem with blogs is that they get taken as something more than people spouting off whatever is on their mind at the time. Take them with a grain of salt.

[Leah123]

Originally Posted by Nightside of Eden

This is one of the (many) reasons I refuse to ever consider therapy again. If the therapist actually cared about me, they wouldn't expect to be paid to spend time with me. The whole arrangement grosses me out, honestly. I have real friends who will listen to me for free. I don't need to hire someone to do that.

I never thought of the therapist as someone to just listen to me. I thought of them as individuals with several years of training and ideally several years of experience in working through mental illnesses and major life issues.

I could find friends to talk to about many things (and actually it's something I'm working on, working from home 60 hours a week isn't too conducive, haha) but the things I need help with, parenting a child with ODD, dealing with PTSD, trauma, my friends don't have the ability to help me heal those issues. I hosted a playgroup to have social time with other parents and for our kids to socialize for years, but that's just not what's needed to really come to grips with the ODD for example.

There is some overlap, but where friends are caring listeners, therapists are trained facilitators, consistent, objective, client-focused, as long as one chooses a great one.

[Jdog123]

As someone who has a MA and PhD in another field, while I didn't pay for my education (I was paid anywhere from $3,000 to $22,000, but most often around $16,000/year) I forewent 8 years of income to come out making the same as I did with a BA. So I lost 8x$30,000 or $240,000. Therefore, that part of her argument is quite flawed.

I also don't think that renting out love is accurate, at least in my experience. My therapist doesn't just love me for the 100ish minutes we spend together a week. She recently went on a 2-week vacation after a really tough medicine episode for me. She left me with 4 cards to open over that period, she recorded a voicemail on my phone as she was leaving for me to listen to when I missed her, she allowed me to email her and she responded, and she called me when she got back into the country as it'd be 2 more days til we saw each other. She also arranged for me to see a colleague if I struggled and got pre-authorization from my insurance company to do so. She didn't bill for this--it was done out of genuine caring and love that doesn't just disappear once we'll stop seeing each other - doing such things will, but the love and caring not. I have a former therapist, stopped seeing her almost 6 years ago, and we still email a few times a year and I saw her when I was visiting the place she lives/where I used to live and we had a lovely afternoon together. I can affirm that we both still feel a lot of love for each other, and I haven't paid her a dime in nearly 6 years.

[feralkittymom]

The part about setting fees based upon the market seems right and fair.

The rest I think says far more about the writer's insecurities and conflicts than anything about the profession or those who seek it out.

[CantExplain]

Originally Posted by puzzle_bug1987

I think there is a lot more truth to it than any of us would like to believe. It's kind of disgusting.

There are certainly similarities. But that doesn't disgust me. I do think it is sad, though.

PS: If you are paying a T for love, I do think you should get what you pay for.

[Outcast_of_RGaol]

I think that people are people and their occupation doesn't necessarily define them.
People take on jobs/careers for a myriad of reasons and the MH professionals are no different.

Some get into it for the money, some get into because they initially wanted to figure themselves out and others got into because they honestly want to help folks.

Whichever type we get involved with is left to chance... whichever type we stick with is our own choice.

The issues about economics and politics and zeitgeists I'll leave alone...

[MoxieDoxie]

The therapist serves us. We pay them for a services and the service is different for all of us. I would not want to see a therapist for free. I feel they would not do the best they could for you for free than if they had to earn their fee. I do not want my therapist worrying about how he is paying his bills. If the client cancels or quits he does not get paid. He put in the work, the years and the sacrifice to get the degrees and go through the training. I admire that. I can not make it through college.I often think about if I had 30 clients just like me. That would be a rough week at the office. He deserves his money even if it is a paid friend. My needs are being met.

[mortalache]

Originally Posted by MoxieDoxie

I can not make it through college.I often think about if I had 30 clients just like me. That would be a rough week at the office. He deserves his money even if it is a paid friend. My needs are being met.

I often think about this, too and do agree. For the years of experience and variety in experiences with clients, I can really appreciate how helpful the relationship with my therapist has been.

Originally Posted by Nightside of Eden

This is one of the (many) reasons I refuse to ever consider therapy again. If the therapist actually cared about me, they wouldn't expect to be paid to spend time with me. The whole arrangement grosses me out, honestly. I have real friends who will listen to me for free. I don't need to hire someone to do that.

I have friends who are professional musicians. They tell me that they are regularly asked to perform for free because "they like what they do". I have friends who are authors. They might write something as an one-off thing for a close friend's wedding or fiftieth birthday, but they don't, as a rule, write for free - yet many people expect them to. Nor should a psychotherapist who has 5+ years of specialised training plus at least a few hundred hours of therapy which they had to pay for, be asked to work for free.

Everybody doesn't need a paid professional. If you have friends whom you can talk to, that's great and I am rather envious. But a therapist is not a friend, and most people who lack the professional training cannot deal with complex traumas, severe depressions, aftereffects of abuse, for week after week after month after year. And there is certainly no love in the bargain.
(I won't comment on the original blog post since I don't inhabit the same world as the writer.)

Originally Posted by Nightside of Eden

This is one of the (many) reasons I refuse to ever consider therapy again. If the therapist actually cared about me, they wouldn't expect to be paid to spend time with me. The whole arrangement grosses me out, honestly. I have real friends who will listen to me for free. I don't need to hire someone to do that.

The point of therapy is to understand yourself better ( your inner emotional life and maladaptive behaviours) so you can make positive changes and get love from realationships outside of therapy.

Prostitution can teach a man ( or woman) about the mechanics of sex, but will never be good as sex in a loving realationship ( for most people anyway). The same with the T client realationship in that it's a poor version of a realationship outside of therapy . The T doesn't even really have to care at all, as long as they help you improve in your life, are understanding, and don't violate boundries. Often a caring T can be more detrimental then a T that feels indifference.

Never forget why you're in therapy. It's not a paid friendship, although it can feel that why at times. You paying someone to help you make genuine realationships outside of the therapy.

[CantExplain]

Originally Posted by Outcast_of_RGaol

I think that people are people and their occupation doesn't necessarily define them.
People take on jobs/careers for a myriad of reasons and the MH professionals are no different.

Some get into it for the money, some get into because they initially wanted to figure themselves out and others got into because they honestly want to help folks.

Whichever type we get involved with is left to chance.

But we can ask them. An excellent interview question for a new T is, why did you become a T? (And if they don't answer, they've got their Blank Slate set too high.)

[Favorite Jeans]

Originally Posted by Nightside of Eden

This is one of the (many) reasons I refuse to ever consider therapy again. If the therapist actually cared about me, they wouldn't expect to be paid to spend time with me. The whole arrangement grosses me out, honestly. I have real friends who will listen to me for free. I don't need to hire someone to do that.

Not at all suggesting that you should go back to therapy, just finding your argument very flawed.

Do you think nurses and teachers care about their patients and students? Why does no one ever suggest that if nurses really cared, they'd do their jobs unpaid? Does getting paid cheapen the compassion they show to people who are ill and dying? Is the only good T a destitute T?

I have friends who listen to me for free too. I feel lucky to have them. But I also listen to them, they are not bound to keep what I say confidential, they are not all good listeners and there's a limit to what I can fairly ask them to hear. I love that paying me T absolves me of any other responsibility toward her. It's all about me. I can't ask that of a friend.

Also, do you really want to work through issues of abuse, grief, shame, abandonment etc with a friend? I don't. I pay my T for her skill set and knowledge. I don't think it's a job anyone off the street could do equally well. It takes a lot of work to be a good T.

Finally, you know what? About renting out love: being good at sex work no doubt takes a lot of work and skill too. I think that comparing every financial or emotional transaction to sex work, as though that somehow renders it cheap or insincere, is such puritanical silliness. I could say "I really wish I could have more from my T than my one paid hour. It makes me feel sad and angry that I can't." Or I could say "T is a [hooker] for not loving me and taking me home with her!"

[stopdog]

I don't think caring comes into it one way or the other. They get paid to do a job of some sort, even though I don't think they do much or that it is especially difficult. I think of it more like renting space than selling sex. If one of them (or anyone else who thinks of themselves in caring professions - I don't really think nurses or mds care either - but if they do - then fine) manages to care - it is not really the point of the endeavor from what I experience.

Originally Posted by CantExplain

There are certainly similarities. But that doesn't disgust me. I do think it is sad, though.

PS: If you are paying a T for love, I do think you should get what you pay for.

It is sad. Sigh. And I know I am cynical.

[boredporcupine]

As someone who is a T-in-training, I do think there is a sense in which therapy is renting out love. As a T, during session you need to put aside whatever judgments you might have about your client and focus on your desire to help that person and how to accomplish that, and you could see that as a kind of love. But I don't think it's love in the ordinary sense and I don't think that's most of what you are paying for, either.

Without having trained as a T, it is probably not clear to people how very different it is to be talking to a friend than to a client. Let's say I go out to lunch with a friend. First of all, I can expect to spend at least half the time talking about my own life and problems, something that I would never do in session with a client. Second, I don't have to keep any records about the conversation, or do any paperwork about it, nor do I have to keep anything from it confidential, all things I would be obligated to do with a client. Third, I can expect that my friend probably isn't going to spend the whole conversation talking about all the worst things that have ever happened to her in her whole life or her most shameful secrets, etc. Fourth, I can respond to whatever she says naturally, without having to focus all my attention on responding in the most therapeutic way possible. If I need to take a phone call or text while in the middle of a conversation with my friend, it wouldn't be considered totally egregious. If my friendship with my friend breaks down, I don't have any obligation to work it out with her or to refer her to another professional. If I say or do the wrong thing to my friend, I can't be reported for it and risk losing my entire career.

In a nutshell, I know that I am a good friend, and it is possible that given the chance, someone might want pay by the hour for me to interact with them as a friend (although I would not be comfortable with this arrangement and I'm pretty sure it couldn't work out). But it wouldn't be therapy or even closely resemble it.

I wish I could rent love. I really need an hour or 2 of it right now. I'd pay. I keep paying and paying my t, but I'm still waiting. All I get in return is this stupid therapy. What is a person to do with that?

Seriously though, if I could pay to get more I might do it. I am paying her, every week, but still not getting what I need. I know she loves me, but she is not giving it to me. Therapy is so hard.

[CantExplain]

Originally Posted by boredporcupine

Let's say I go out to lunch with a friend. ...nor do I have to keep anything from it confidential, all things I would be obligated to do with a client.

Perhaps you underestimate how much you keep confidential between friends. Perhaps it comes naturally to you.

In my youth, I was always getting into trouble for passing on things I didn't realise were supposed to be confidential. Part of the burden of Aspergers!