I’m not good about money. I never have been. Managing my own finances has never been a problem, but setting patients’ fees is an entirely different matter.
Early in my career I was treating Sharon, an artist, who told me how much she made yearly from her art. It wasn’t much. My regular fee wasn’t much in those days either. Still, I reduced my fee. Several months passed. In the course of one session she began to talk about the apartment buildings she owned that had been left to her by her now deceased parents. I was shocked, and angry, too angry to say anything at the time. The next session I was ready.
“Sharon,” I said, “Last session you talked about being a landlord. Can you say why you didn’t tell me you owned apartment buildings when we first discussed your income and your fee?”
“It never came up,” she replied. “We were talking about the money I made from my art.”
“That’s true. But don’t you think not mentioning your other income was dishonest?” I asked.
“No,” Sharon replied blithely.
“Really? You don’t feel you were hiding your rental income so that I’d reduce your fee?”
“My father used to say never offer any information you’re not asked for,” she said.
“You experienced your father as a ruthless, indifferent, uncaring man. And now you’re modeling yourself after him?”
“I never thought of it that way. It’s not something I decided to do. I guess I just do it automatically when I deal with something business related. I’m sorry. You’re right. It wasn’t fair of me.”
So that situation had a satisfactory ending both financially and therapeutically in that we were now able to explore Sharon’s identification with her father.
More recently, the result wasn’t as positive.
I receive a call from Jackie, referred to me by a former supervisee. We set up an appointment and as we are about to get off the phone she asks my fee. Although I prefer to discuss fees in person, I answer her question and tell her my regular fee is $250 a session. She gasps. Without a moment’s hesitation, not knowing anything about her finances, I offer to see her for $150. She agrees and comes in at the designated time.
Jackie sought treatment because she and her husband just learned that he is sterile and are now wrestling with whether or not to adopt. Jackie is also trying – not very successfully - to not be angry with her husband for a medical condition beyond his control. Being a mother has always been Jackie’s dream. Her mother died when she was only a year old, leaving her to be raised by rigid, rejecting grandparents. We discuss her desire to give her own child an experience she herself cannot remember ever having. She understands, but remains focused on her anger at her husband and his failure to give her what she has always wanted.
As the therapy progresses, I learn that their marriage has never been fulfilling for her. She describes her husband as both withholding and an inadequate lover. She stays in the marriage because she’s dependent on him. And for financial reasons. She has a seven-bedroom home on three acres of land, horses, a cook, and a housekeeper.
I am not happy. I reduced my fee for a woman with huge financial resources! And it’s my own doing. She hadn’t lied to me. She hadn’t withheld information about her wealth. All she had done was gasp and I lowered my fee!
As we approach the new year, I tell Jackie that come January I will be raising her fee to $250. I understand that a $100 increase is a lot, but given her financial circumstances, it doesn’t seem unreasonable.
“Well,” she says, “I was planning on stopping anyway. All this talking isn’t getting me anywhere. My husband is still sterile and I just have to stop being angry at him and decide whether or not adoption will work for me.”
“Do you think your decision to stop is related to my talking about increasing your fee?” I ask.
“No, not at all. You’re right. I can afford it. But I don’t think this is helping. So why should I bother continuing?”
“Can you say, Jackie, how you felt about my raising your fee or, for that matter, how you felt when I lowered it when we talked on the phone.”
“I don’t know. I didn’t think about it.”
“Can you think about it now?”
She shrugs.
“Do you think you felt given to when I lowered your fee, given to in a way you haven’t experienced much in your life and that now you feel I’ve deprived you yet again?”
“You’re making too much of this. You always do. You over analyze. It’s just time for me to leave.”
And so I lost Jackie. As a result of my difficulty dealing with money.
I am waiting for Fran, a 38 year old successful interior designer, to arrive for her fourth, twice a week session. My clock says 11:03. She’s a few minutes late. I’m surprised since she seems like a responsible, conscientious person who goes out of her way to be “the good girl.” Still, she could have been held up by a client, or perhaps just the traffic.
11:08. I’m running through our sessions in my mind. We seemed to have a good connection. Although a relatively anxious person, Fran talked freely, telling me about her doubts about her competency despite her obvious success, her parent’s divorce when she was five, her mother’s unrelenting criticism, and the time her mother’s third husband came on to her.
11:15. I call and get Fran’s voice mail. I leave a message saying that I hope she’s all right and asking that she please call me. I spend the rest of her session trying to read, hoping the phone will ring, and replaying our last session in my mind.
That was the session she told me about her step-father’s advance. She was an adult and presented the incident as though she was disgusted by it, but not obviously traumatized. Had I minimized the trauma? Had I not looked deeply enough at her underlying feelings? Did I give her the impression that I didn’t want to hear about it?
Or was there something else that led to her not coming today or abruptly terminating? She mentioned wanting to write a book about her experiences as an interior decorator, especially some of the clients she’d worked with over the years. I was certainly supportive of the idea. But does she know about the book I wrote? Did she feel hurt, perhaps rejected, that I didn’t acknowledge it and talk with her as a possible fellow-author? But that’s ridiculous. What if she didn’t know about my book? Bringing it up would have seemed irrelevant or even competitive.
Time for my next patient. Time to put Fran in the background. At the end of each session I check my messages. Nothing from Fran.
Finally, at 4 there’s a message that says, “I’m really sorry. I got my schedule entirely confused today. I knew I was supposed to come and then it was just gone from my mind. I’ll see you on Thursday.”
I am incredibly relieved. Perhaps I didn’t do anything wrong after all. Perhaps there was something going on with Fran that had nothing to do with me. Well, that’s probably not true either. Perhaps her not coming was related in some way to our interaction, or her feelings about me or our relationship, but that doesn’t mean I did something “wrong.”
It’s actually noteworthy that I went so easily to feeling that I’d done something “wrong.” Perhaps that reflects not only my tendency to examine and take responsibility my own feelings and behavior, but also Fran’s feeling “bad” or “wrong” herself.
“I’m really, really sorry about Tuesday,” Fran begins. “I don’t know how I managed to forget my appointment. I never do things like that. I feel awful about it.”
“Do you have any thoughts, Fran, about why you might have forgotten the session? I ask not so that you’ll blame yourself or beat yourself up, but to see if there might have been something you were trying to communicate.”
“It’s interesting that you say I shouldn’t blame myself or beat myself up. I was doing that, but I think I was doing that after our last session anyway,” Fran says, blushing.
After a few seconds she continues. “You know that incident I told you about my mother’s husband coming on to me?”
I nod.
“Well, he did. But I kind of led him on. … I feel so awful telling you this. … He was always such an asshole, not that I ever lived with him or anything. And, I don’t know, I guess it made me feel powerful to be able to manipulate him in that way. I feel like such a piece of shit.”
I now understand why feelings of “wrong” had been floating around for both myself and Fran. I also think that Fran’s “leading him on,” was a way for her to get back at mother as well as her mother’s husband, but I decide that interpretation is best left for another day. Instead I take a more supportive approach. “We’ve all done things we’re not proud of Fran. What’s most important is to deal with our feelings of shame and guilt and to understand our behavior as best as we can. And that’s why you’re here.”
