Therapy in Times of Financial Crisis

As therapists, many of us have clients who are faced with the grave prospect losing their jobs, homes, or life savings. Many of us, along with millions of people in the US and around the world, are concerned and frightened by the growing economic crisis. In fact, the crisis people are faced with may be much more than economic: many may experience a crisis of faith in our way of living and understanding of our world.

Therapists talk with greater ease about abuse, depression, anxiety or even death and sex than about matters related to money. However, this is NOT the time to avoid the subject of financial health. Avoiding discussions about financial concerns with many of our clients would amount to ignoring the elephant in the room. Such avoidance can be confusing to clients. Worse yet, it is “crazy making” not to address issues that are both emotionally charged and perceived as critical to a client’s own survival.

The fact that we, as therapists, may be facing financial crises ourselves and be fearful about our own financial futures, can make it even more difficult to openly face and discuss the issue with our clients.

Following are some thoughts, comments, and suggestions for how to interact with clients regarding the current economic crisis.  

General Points

• Do not avoid the subjects of fear, panic or despair around financial issues if your clients bring it up or if you suspect it is on their minds.
• Remember that people worry about money regardless of how much money they have in savings or how many houses they own.
• Invite clients to express their financial concerns and respond with empathy and compassion.
• Acknowledge your own concerns and fears and, if appropriate, get personal or professional support to help you deal effectively with your own anxieties and despair.
• Many clients can benefit simply from sharing their deepest fears, sense of failure, etc. with an empathic ear.
• Help clients think about the issue in realistic terms by assisting them in differentiating between exaggerated anticipation of doom and more realistic possibilities.
• Money is one of the most potent metaphors of our culture. In fact money, sex, and time rank in the top three.
• Matters of money are often tied to security, self-esteem, identity, power and much more.
• Help clients to understand the power of metaphors and how they are at work, positively or negatively, in times of crisis.
• Do not hesitate to get into the nitty gritty details of your clients’ situations.
• Some clients can benefit by making and sharing detailed budgets.
• Help your clients brainstorm about what they can change by cutting or reducing expenditures.
• Refer to financial advisers or accountants if necessary.
• Teach your clients stress management techniques, such as breathing, thought stopping, or taking a break from the tension by watching movies, exercising, or practicing prayer and meditation.
• Introduce them to helpful resources in the community.
• Explore with them their spiritual or religious beliefs to find help in coping with their situation.
• Inquire how the financial crisis may affect their marriages, intimate relationships, or relationships with children.
• Pay attention to suicidal ideation and note premature thoughts of divorce or separation.
• Share with clients your thoughts, feelings, or coping strategies, as clinically appropriate and at your comfort level.

Practice Management:

• It is time to be flexible with clients in regard to fees, frequency of sessions, or even taking a break from therapy. (See online course, Fees)
• Do not hesitate to bring up the issue of whether they can afford therapy or not. If you do not bring it up, they may simply drop out of therapy.
• Be responsive when clients suggest reducing the frequency of visits, seeing you at a reduced fee, or propose a bartering arrangement.
• When clients request a reduced fee, take the time for compassionate negotiation of a sliding scale, if appropriate.
• Some clients are too proud to pay a reduced fee and prefer to reduce frequency of sessions or to barter.
• Some clients may prefer to shift to a cheaper and less time consuming (including driving time) mode of psychotherapy, such as telehealth, where therapy is conducted by phone and/or email. (See our online course on TeleMental Health.)
• Taking a break may be appropriate with some clients. Most clients do not like being pressured to stay in therapy and will drop therapy anyway. If they see you as caring and flexible, they are more likely to come back. (See online course on Termination.)
• Be cautious with allowing clients, who are already deep in debt, to defer payments.
• Some clients may propose a bartering arrangement. Be open, receptive and thoughtful. (See online course on Bartering.)
• Learn about and teach your clients about the philosophy of intermittent-long-term therapy, where clients come back to therapy at different times and junctions during their lives.
• When clients have suicidal ideation, attend to it appropriately and document your consideration, decision-making, and intervention.

Therapists’ Self Care:

• If necessary, get personal or professional support to help you deal effectively with your own financial concerns.
• Practice what you preach and employ stress management techniques that are known to be effective.
• Volunteer in ways that will assist the less fortunate. Sponsor food drives, book drives or toy drives. Increase your civic responsibility. Pay it forward.
• Talk to people who will focus on solutions and positive possibilities rather than those who exacerbate your fears and worries.
• If you are so inclined, focus on spiritual practice and community.

Crisis is an Opportunity

• For many of us, and our clients, the financial, housing and job crises may trigger other emotional, existential, or spiritual experiences.
• When appropriate, work with your clients and yourself on the potential blessing of the crisis. These may vary:
  • Deeper appreciation of intimate, loving and community connections.
  • Developing better priorities by defining what is important, necessary, essential, and sustaining in contrast to what is unnecessary, frivolous or lacking in essential quality.
  • Finding entertainment that costs nothing but brings people into closer relationship with each other. Examples would be playing board games, card games, taking hikes, etc.
• Get into the habit of sharing, borrowing, re-using, and creating rather than buying and contributing to pollution.
• Save for purchases rather than buying on credit.
• Question the consumerist mentality and identity.
• It can be empowering for both therapists and clients to see ourselves not only as innocent victims of greedy Wall Street brokers and deceitful loan officers, but rather as co-contributors to the crisis by the way we consume, live, or vote. In other words, seeing our part in entering a crisis can help us see our way out of it.

Related online courses: Fees In Therapy ~ TeleMental Health ~ Termination ~ Bartering