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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by pegasus on January 11, 2012, at 15:43:03
I stumbled upon this blog post today:
http://whatashrinkthinks.com/2011/09/06/what-you-pay-for/
I have to admit that I had not managed to come to the same understanding of therapy fees that this "shrink" articulates. What she says seems reasonable, and perhaps even helpful. But I'm also left feeling uneasy. Maybe it's how she allows for the possibility that she might not like or care about her clients? Even though, she kind of frames the liking and caring as being something she offers (and receives) for free, independent of the $$ exchange.
Can anyone help me put my finger on what is uncomfortable about this?
- peg
Posted by Dinah on January 11, 2012, at 16:27:24
In reply to What you pay for, posted by pegasus on January 11, 2012, at 15:43:03
Maybe this sentence?
"If the treatment is sometimes satisfying, gratifying, inspiring, warm, or pleasant for me, that is a nice perk, a tip perhaps like the spare change that I sometimes find in the cracks between the cushions of my office couch."
Coupled with
"When an acquaintance tries to tell me a long, detailed dream at a social function, Im bored, burdened, looking for some way to extricate myself from the conversation as it is slips into a non-mutual place."
That seems to be saying that she finds therapy pleasant about as often as she finds spare change in the cushions of her couch.
And that the money helps her find interesting what she wouldn't find interesting in any other venue. Not because she wouldn't be using her skills and intellect in those other settings. But because no one is going to pay her.
My therapist said something similar once, not about money but about boundaries. That the boundaries are what makes it possible for him to care for me consistently and not be burned out.
I didn't get the warm fuzzies, I can tell you.
If my therapist had this conversation with me, in the terms used there, I'm not sure I'd understand in what way they are saying it is not similar to prostitution.
A person is collecting money for engaging in behavior they might otherwise find, at a minimum, tedious. They provide the client with behaviors that, if provided by those not being paid, could be considered caring and loving.
What's that difference again?
I think I prefer discussions of money focused on the therapist's need to make enough money to continue to provide services. Not on the therapist requiring money to make our interactions palatable.
Posted by Anemone on January 11, 2012, at 16:28:53
In reply to What you pay for, posted by pegasus on January 11, 2012, at 15:43:03
Hi Pegasus,
Thank you for sharing this very interesting blog post.
Could it be, (I am just guessing from my own feelings,)... maybe you are uncomfortable because even though what the author said was reasonable, still you wish that all therapists could 100% like their clients with no possibility of dislike, and care without the condition of money? Maybe you wish the T could be there to take care of you, completely needless and selfless?
My T's regular fee is $100 and she sees me for $15 because I am very poor, struggling with career problems. I feel very uncomfortable and grateful and uneasy about this. If I could, I would pay her $1000000000000000 per second. She is an excellent T with tons of education and deserves money. (I'm trying my best to build my career, earn more money so I can pay her more.)
Posted by Dinah on January 11, 2012, at 16:34:06
In reply to What you pay for, posted by pegasus on January 11, 2012, at 15:43:03
Oh, then there is this sentence...
"Every few years, I encounter a certain kind of wounded, fearful client who in order to wiggle out of any vulnerability attempts to hang onto their sense of power and privilege by insisting that the therapeutic fee makes therapy the equivalent of prostitution. "
Power and privilege? Really? In therapy?
Yuh huh.
I wouldn't appreciate a therapist making those kind of judgments about me over a perfectly understandable concern.
Posted by Anemone on January 11, 2012, at 16:52:26
In reply to Re: What you pay for » pegasus, posted by Dinah on January 11, 2012, at 16:27:24
Dinah, I like what you said. That's what I was trying to say. I think you say things so eloquently, and Pegasus too. Sorry Pegasus if I said it wrong.
Posted by Daisym on January 11, 2012, at 19:08:32
In reply to What you pay for, posted by pegasus on January 11, 2012, at 15:43:03
Why do therapist think anyone really wants to read what their private thoughts are? I mean, we all do, but we really don't.
She sounds like an arrogant sort of person - I like part of what she said but "thee does protest too much" comes to mind when you read this.
Is it a crime to feel passionate about your work and love helping people? If so, I'm in big trouble. I get a salary but the work I do - the babies and children - are the reason I get up in the morning.
I sort of feel sad for her. What a loss to not love the intangible parts of the relationship. And how lonely.
Posted by emmanuel98 on January 11, 2012, at 19:26:22
In reply to What you pay for, posted by pegasus on January 11, 2012, at 15:43:03
I get it. I've talked to my p-doc about this many times. He says he a care-giver by nature and this relationship allows him to care for me without expecting anything in return except my trust and honesty. Once I said he only cared if I paid him and he said that's not true. If you lost your job and insurance I would still see you and we would figure out what you could afford. Maybe only $10 or $20 a week. He has also said that a therapist must find something to love and respect in a client or they can't do therapy with them.
Posted by emmanuel98 on January 11, 2012, at 19:32:36
In reply to Re: What you pay for, posted by Daisym on January 11, 2012, at 19:08:32
Once I called my SW therapist to change an appointment time and she changed it in her book, but forgot to call me. So I came at my regular time and she had another client. We agreed that I would return in an hour. When I came at first I saw a client leaving and when I came again I saw a client coming. It depressed me so much. This parade of clients of which I am only one. I couldn't talk to her, I was so upset, but I told my p-doc the next day and he said if you were our only client we couldn't afford our rent. But he reminded me that therapy is very different from teaching college (which is what I do). I see 90 students a semester and have a hard time remembering their names. He said most therapists see 25-30 clients a week, spend an hour with them over a long period of time and come to know them and care for them very much.
Posted by pegasus on January 12, 2012, at 8:57:53
In reply to Re: What you pay for » pegasus, posted by Dinah on January 11, 2012, at 16:34:06
Yes. It's this bit:
. . . in order to wiggle out of any vulnerability, attempts to hang onto their sense of power and privilege by insisting that the therapeutic fee makes therapy the equivalent of prostitution . . .
That gets me. Isn't seeing the similarity between therapy and prostitution (versus the spontaneous, organic caring relationship we all crave) putting your finger right on the heartbeat of that vulnerability? If I was willing to just take the apparent caring at face value, that might feel a lot more secure.
Plus, there's the judgmental tone. I don't like that.
But, maybe it's helpful to think that I am able to reciprocate to my T in the form of money, when I can't give him anything else of value. So, when I can't believe in his caring, I can still feel like it's OK to expose him to the dirty underbelly of my psyche week after week.
I think I'm actually glad to have read this post, even if I think she could frame it all a bit more compassionately. I hate to think what her clients go through, reading this. And you know they do.
Peg
Posted by Dinah on January 12, 2012, at 9:56:48
In reply to Re: What you pay for » Dinah, posted by pegasus on January 12, 2012, at 8:57:53
Yes, I know they do. :(
I think you're selling yourself short. You have more to give him than cold hard cash. If he's any sort of decent therapist, he should find professional interest and satisfaction in working with you.
And... Have you ever read Kottler's "The Client Who Changed Me"? I think any long term therapy results in some sort of change for both parties. My therapist says he's a better therapist because of me. And that's directly related to the fact that I'm a difficult client. I challenge him to find new ways of doing therapy when the old ways aren't really working. I help him think of things in different ways.
You can show him your dirtiest underbelly. Given his job, it's likely not that shocking to him. But even if that's all you ever did, you'd be offering him trust. And a chance to exercise his skills. I think it extremely likely you offer him more than your dirty underbelly. If you offer him what you offer Babble, that seems more valuable than cash to me.
I'm as cynical as they come about money and therapy. I know darn well that my therapist's availability will end when the income stream ends. And even if I frame it generously, his caring will decrease as absence makes the heart grow forgetful. At any rate, I won't experience his caring. But even I don't think that all I have to offer is cash. If I ever did feel that way, I'd tell him to go f*ck himself and walk out.
I know therapy is for our benefit, not theirs. But I hope your therapist occasionally shares with you the ways he is enriched by your therapeutic relationship, aside from the money. Or at least mentions that he gets some sort of satisfaction from conducting therapy more often than he finds spare change in his couch. :)
Posted by Daisym on January 12, 2012, at 13:25:45
In reply to Re: What you pay for » pegasus, posted by Dinah on January 12, 2012, at 9:56:48
I posted a response on the blog site that pointed out, in my opinion, that if money is the equalizer - she does it because she gets paid, no matter how unpleasant -- doesn't this make it MORE like prostitution, not less? I also said that I do not pay my therapist to keep his own stuff out of my therapy. I pay for his knowledge, skill and experience, his help and his professionalism. Keep his own stuff out of my therapy is part of being a professional. Sort of like keeping your hair out of someone's food when you are a chef. I don't pay extra for the no-hair plate. But I won't go back if there is hair in my food.
My response was there yesterday and is not there today. I find that kind of interesting.
Posted by Dinah on January 12, 2012, at 19:56:10
In reply to Re: What you pay for, posted by Daisym on January 12, 2012, at 13:25:45
Well, I suppose that explains the fact that all the comments to the entry were positive. I couldn't quite figure that out.
Thanks for bringing it to her attention. Maybe she'll consider the words even if she deletes them.
Posted by Raisinb on January 13, 2012, at 17:42:10
In reply to What you pay for, posted by pegasus on January 11, 2012, at 15:43:03
I have a different take--I read it and actually really liked it. What I like is the honesty and the reassurance that if they can't care (in all the complex meanings of the term) they don't take you. Isn't that awesome?
I teach and also manage other teachers. People make boundary mistakes with me all the time--for instance, people who work for me think that it is my job to listen to them vent (ie, they confuse their boss with their therapist). Those people make me look for an excuse to get rid of them, because in aggregate, it ain't fun. Some (adult) students think it is my job to "care," which to them means put up with whatever nonsense they feel like dishing out. Over the years I have come to feel more and more that to minimize conflict and keep the relatioinships good and me from kicking someone, it is absolutely crucial to make it clear to people what and what isn't my role.
The therapist who wrote this is articulating her emotional responsibilities professionally and personally, and being very clear about it. If all Ts were this clear, there would be less burnout and resentments towards clients, IMHO.
Posted by Daisym on January 13, 2012, at 18:39:41
In reply to Re: What you pay for, posted by Raisinb on January 13, 2012, at 17:42:10
I don't disagree with what you wrote, nor with those parts of her blog. But I think what rattled me was that instead of just discussing what she would or wouldn't do, or what her responsibilities are, or aren't, she equates money with an equal relationship and really says, "I only do this for the money."
And then there are those little jabs at clients -- subtle -- but almost passive aggressive in tone and word choice. It felt demeaning to me, and a little shaming of clients who want something "more" from her.
But I totally agree that clarity is really good and being forthcoming about the business aspects of this relationship would be better for both sides of the couch.
Posted by Dinah on January 13, 2012, at 18:56:48
In reply to Re: What you pay for » Raisinb, posted by Daisym on January 13, 2012, at 18:39:41
My therapist was actually offended on behalf of therapists. He didn't think this was what clients paid for at all. He liked to think they paid for his expertise. His training and experience. As Daisy says, the keeping of his sh*t out of the therapy room was a part of the professionalism with which he operated. He didn't think that required extra pay. :)
As I've said, he does tend to be generous in interpretation. His most generous guess was that this therapist doesn't provide actual therapy as in "treatment", but rather perhaps provides the listening and counsel that he associates more with "counseling". You wouldn't look to a friend for treatment, whether or not you paid for that friend to focus on you alone.
He also conceded that there were things a client might also find offensive. :)
He *did* say that he'd be terrified to write a blog about therapy - or at least about a therapist's relationship with their clients from a business point of view. I suggested that if he ever do so, he read a lot of Yalom before attempting it. There's a writer who makes therapists look good.
My therapist has a fair amount of wisdom in the larger things.
Posted by emmanuel98 on January 13, 2012, at 19:11:34
In reply to Re: What you pay for, posted by Raisinb on January 13, 2012, at 17:42:10
> I have a different take--I read it and actually really liked it. What I like is the honesty and the reassurance that if they can't care (in all the complex meanings of the term) they don't take you. Isn't that awesome?
>
My p-doc has always said that if he doesn't like someone, he gets rid of them. I ask him how. He says that it's usually obvious after a few sessions and he'll just tell them this is not working out and refer them. When I asked him recently if he still liked seeing me he said, if I didn't want to see you, I'd get rid of you. I have 40 years of experience and know how to get rid of people I don't want to deal with.
Posted by Raisinb on January 13, 2012, at 23:52:15
In reply to Re: What you pay for, posted by Dinah on January 13, 2012, at 18:56:48
It's interesting. I can identify with it from both sides; right now, because I am under considerable job stress, I feel the T, but next week when am feeling insecure about therapy, I might hate this woman's guts. I like her a lot better than that stupid "ideal client" woman, because that therapist was portraying herself in a dishonest, Pollyanna way. She was Stepford in the worst way.This one is pissy and arrogant, but comes off as real.
Posted by pegasus on January 16, 2012, at 8:21:08
In reply to Re: What you pay for, posted by emmanuel98 on January 13, 2012, at 19:11:34
Wow. That would terrify me. How do you feel about it?
Posted by pegasus on January 16, 2012, at 8:28:34
In reply to Re: What you pay for, posted by Raisinb on January 13, 2012, at 23:52:15
Yeah, I have a similar ambivalence. I agree that she makes little demeaning jabs at her clients, which I never like to see. Especially in such a public place.
And on the other hand, I read some of her other posts about money, and I like the way she talks about setting a fee that is good for her *and* the client. I agree that it can be helpful for the fee to be enough that it hurts a little, but isn't financially out of range. I definitely take therapy more seriously because of all the money I'm spending. It makes me get down to work sometimes when I don't want to. And an early discussion of financial needs on both sides seems like it would make the whole thing feel like more of a cooperative enterprise, and puts the business aspect of it right on the table from the get go.
Unless it scares the client away. I guess we all have our different issues with money, and it seems like it would be hard to account for that using any general strategy.
- peg
Posted by emmanuel98 on January 16, 2012, at 20:20:25
In reply to Re: What you pay for » emmanuel98, posted by pegasus on January 16, 2012, at 8:21:08
> Wow. That would terrify me. How do you feel about it?
It doesn't upset me. We've been seeing one another for a long time and he is just very frank with me. Also he gets sick of my insecurity with him. I always worry that he dislikes me. He first said it should be obvious after all this time that he likes me. Then he said the thing about how, if he didn't like me, he'd wouldn't keep seeing me.
Posted by emmanuel98 on January 17, 2012, at 19:33:21
In reply to Re: What you pay for » Raisinb, posted by pegasus on January 16, 2012, at 8:28:34
I am seeing this DBT therapist and she told me that she was thinking about going off the insurance panel I had because the reimbursement rate was so low. My p-doc met with she and I and both felt I should see her every week and have her take primary responsibility for my suicidality. She was reluctant because of the high risk and low fee. So let's talk about compensation, my p-doc said. My insurance company allows her only $65/hour (including my $20 co-pay) while they allow my p-doc $125/hour. We agreed that I would pay her the difference between her regular rate and the insurance rate, rather than have her go off the panel, which I couldn't afford at all. This is against insurance rules, but as my p-doc said, it's just between the three of us. I understand her resentment about the fee. I myself felt it was unfair how badly she was compensated. She and I both feel much better about the whole situation now that she is getting what I feel is a fair fee. She does have to pay for an office, a phone, her mortgage and living expenses. If she is going to take on responsibility for someone who is stressful in terms of chronic suicidality (and I know I am), it's only fair and right that she should receive a reasonable fee.
I think it's terribly unfair that my p-doc gets double what she, a social worker, gets from the insurance for essentially the same service. And I know they underpay him compared to what he could get privately. But, as he told me once, he doesn't need the money and doesn't see me for the money. He could make more doing med visits, but likes doing therapy.
> And on the other hand, I read some of her other posts about money, and I like the way she talks about setting a fee that is good for her *and* the client. I agree that it can be helpful for the fee to be enough that it hurts a little, but isn't financially out of range.
Posted by emmanuel98 on January 17, 2012, at 19:35:26
In reply to Re: What you pay for, posted by emmanuel98 on January 16, 2012, at 20:20:25
Then he said the thing about how, if he didn't like me, he'd wouldn't keep seeing me.
Mistake. If he didn't like me, he would stop seeing me.
This is the end of the thread.
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