Money and Psychoanalysis

By William G. Herron, Ph.D. New Jersey Institute for Training in Psychoanalysis
 

Posted by permission of author. Electronic version was received from author 10/24/07. Copyright by Dr. W. G. Herron.

 

Psychoanalysis has a history of “money avoidance.” This is a function of ambivalence about money matters by both patients and analysts. The meaning of money is explored for both groups. Recommendations are made to facilitate the frank discussion of money as an integral part of the analytic process.

 
Introduction

Psychoanalysis is a form of treatment in which patients can and should talk about whatever comes to mind. The process of relative free association, because some material is repressed, results in a subsequent process of sorting out to determine relevance, make interpretations, develop insights, and effect behavioral changes. During this analysis attention is paid to both what is said, and what is not. Repressed and suppressed issues are of particular interest, once discovered, because they involve what patients consider disturbing to their psyche. Prominent in this category is the matter of money.

Over time a number of books have addressed this concern (Bergler, 1959; Herron & Welt, 1992; Klebanow & Lowenkopf, 1991; Krueger, 1986). However, money has kept the status of reluctant disclosure at best, while other uncomfortable topics, as sexual practices, are easier to access. This article examines the reasons for this situation, including the contributions of both patients and analysts, as they collude, often unconsciously, to maintain a tense and unproductive silence.

 
Patients’ Attitudes About Money

Money is important to everybody, including those who try to insist it is unimportant. It is basic to survival, as well as thriving, success, and excess. At the same time, it has always been a source of ambivalence with a rich variety of individualized meanings.

Developmentally, money has its roots in the anal psychosexual phase and the relational rapprochement phase when ambitendency is turning into ambivalence. These are phases of control and exchange. The person gives, but under certain conditions imposed by authority figures and social norms, and gets rewarded in exchange. Withholding, or inappropriate giving, may result in punishment. The superego, both in a social and moral sense, is coming into play, preparing for the more intense affects of the oedipal situation and object constancy. Money symbolizes an aspect of the body-ego, as well as a segment of self-representation, both subject to superego ideals. As a result there is a social coating on the topic of money. Patients understand that money is not the essence of any person, at the same time that they view monetary well-being as representative of positive self-esteem that engenders evaluation by others. Such a view has been congruent with analysts’ views as well, in turn supporting a rather discreet style of handling money matters during analysis.

For example, a detailed discussion, including inquiry by the analyst, is more likely to occur about a patient’s sexual or hostile behavior than it is about a patient’s finances. Both analyst and patient will settle for a patient’s assertion that he got a “substantial bonus,” but a similar generalization would generate further questions if the patient said, “I hit my wife.” Given that psychoanalytic therapy emphasizes that everything means something, it is not useful to apply social conventions in the area of money. It is appropriate to be sensitive to patients’ anxieties, but that does not have to mean the exclusion of meaningful inquiry about money.

Patients’ reluctance to talk about money is engendered by a variety of motives. Shame is one of them, where patients do not want to appear either “too rich,” or “too poor,” because these alternatives can reflect negatively on their self-image and their self-representation to the analyst. At the same time, some patients use their monetary status as a resistance. For example, a patient may use her wealth as an attempt to impress, or to diminish the analyst, thereby stressing her power inherent in the possession of money. In contrast, a patient may take note of his lack of money in an attempt to have the analyst lower the fee. The cost of analysis can also be a reason to keep silent because some patient are concerned they will be charged more if they have more. This could be a reality if the analyst uses a sliding scale, but the feelings about this are valuable analytic material that is lost if not voiced.

A fascinating paradox is created in which the analyst is privy to secrets of the heart, including embarrassing, previously unacceptable acts and fantasies of sex and aggression, but the analyst is not to be allowed to know a patient’s income, or something as palpable as net worth. Nor does the patient expect the analyst to ask, and frequently analysts do not. It is axiomatic that analysts are likely to know the size of a patient’s penis well before they will know the size of his income. Patients view money as a crass topic, to be discussed only if necessary, and this opinion is frequently shared by analysts because they do not want their helping image potentially tarnished by the thought that analysis is in any way a “purchased relationship.”

It is fascinating that talking about money has become a negative social construction pervading the analytic hour while barriers are being removed to a greater degree in regard to sex, religion, and ethnicity. Admittedly, there is not a total avoidance, but certainly enough of a relative one that it is an essential part of the analytic work to change this.

Freud was right on the money in 1912 when he observed that the ostensible purpose of money was preservation and power, but akin to sex, the issue of money was treated with inconsistency and secrecy. It was then and it still is. He expected analysts to avoid such attitudes and to educate their patients to be open and without shame regarding money matters. He did not realize how difficult a task that would be, or that the taboo would have such endurance. Shame, ambivalence, secrecy, and pathological narcissism continue to accompany an often limited discussion of money in analytic sessions. Analysts have ongoing difficulties pursuing the topic because they are also uncomfortable with their own feeling and attitudes toward money.

 
Analysts’ Attitudes About Money

As psychoanalysis has evolved an additional and different view of motivation and psychic structure has appeared. This emphasizes relative mutuality between analyst and patient, in turn diminishing the authoritarian stance of the analyst and such expectations by both patient and analyst. This means that analysts are potentially more visible to their patients as well as to themselves, which seems as if it should include attitudes about money. O’Dea and Frawley (2001) depict a multiple self as the norm, with that self including integration of contradictions, such as ambivalence about money, as well as willingness to disclose what in the past was unexpressed experience.

This theory acknowledges the contributions of the analyst to the transference, so that the reasons for not exploring monetary issues in sufficient depth cannot be routinely attributed primarily to the patient. It is a theory of co-constructions in which both analyst and patient are striving to operate in more open, conjoined space than appeared to exist in the earlier days of psychoanalysis. All this could make it more difficult for the analyst to avoid money matters, or perhaps ease the way toward money talk.In practice, however, the relational movement has not significantly advanced disclosure of money matters. It has made it more acceptable theoretically for analysts to acknowledge that they too, share “money discomfort,” but the discussion is likely to stop with an awareness that social convention will prevail. Unless the patient is particularly concerned with money, or it is very clear to the analyst that monetary are issues are especially pertinent to the conflicts under examination, money matters remain in the area of minimal disclosure.

Imagine that the therapeutic relationship as it is now designated was turned into a “friendship,” increasing the probability of even greater mutuality. Would this mean that money matters would be more accessible? Not likely, because money is secret stuff, for analyst, patients, friends, and often partners, such as married couples. Money is very “personal.” meaning that that it is only to be talked about up to a point rather than being a topic that is available for a rather unfettered discussion. Paradigm shifts in psychoanalytic

Complicating the issue has been the advent of insurance coverage for psychotherapists. For a time psychoanalysts resisted the idea that health insurance could be used as an acceptable form of payment. To do so puts psychoanalysis in the category of a medical procedure tied to a medical model despite the fact that many of its practitioners are not medicine men (or women), and that it is in many ways an educational process. In addition, the analyst’s value was often thought to be represented by the fee, particularly its magnitude, and the patient’s commitment to the process by compliance with payment. The possibility that any portion of the fee came from, and was determined by a third party, alters that perspective.

At the same time, insurance could make treatment more accessible by reducing the total cost to the patient. Also, analysts from a variety of disciplines were included as providers, allowing them greater availability, and generally, it became possible to charge higher fees because the patient did not bear the total direct cost. Even with insurance, patients continued to pay a fee, preserving a key feature of the psychoanalytic process, namely that it is a professional relationship with its own rather special characteristics. The presence of some fee, or some arrangement requiring effort by the patient to ensure the analyst is a paid participant, establishes a significant boundary for the relationship. It is a major definer of the fact that analyst and patient are meeting for a particular reason, namely to help the patient solve personal problems. Because of that, the fee is always important, and one of the money matters that should always be open to discussion.

Because the fee is necessary for the analyst’s survival, it has the best chance of being discussed, but it also remains a sensitive issue. The idea of being a helper, but requiring payment to provide the help, creates a philosophical struggle for many analysts. The fee also causes some patients to be skeptical about analysts’ motivations. Freud (1912) was aware of the conflict and made the point that the ethical procedure for analysts is to make their needs clear, namely that this is how they make a living and the size of the fee does reflect a desired standard of living. Being an analyst is not designed to foster pure altruism. It is a job.

How does such a realistic perspective fit with the concept of a “special relationship” between analyst and patient? Actually, quite well. Most people have a number of “special relationships” for which they pay a fee in some fashion, such as with an attorney, a financial advisor, or a clergy person. The fee assists in delineating the frame of the relationship, on focusing the relationship on its main purpose, its particular “specialness.” Of course, there are ancillary effects, such as the possible enjoyment of time together, but these are secondary.

Analysts often share the ambivalence and inconsistency of patients in regard to money matters. However, they should not let these feelings prevent them from engaging in detailed discussions about money. In most instances they have been able to get past sexual taboos, so it is now time to take on the “last taboo,” money.

 
Conclusions

Talking about money matters in detail has always been a problem in psychoanalysis for both patients and analysts. This is a function of ambivalence about money creating a social construction of “appropriate avoidance” as a norm. However, this clashes with the psychoanalytic belief in unfettered thought and speech within the analytic sessions. Some selective avoidance is expected, given the transference, countertransference, and resistance issues involved in every analysis, but it is not the best practice to consider money matters an acceptable exception to the view that analysis is the place for free verbal expression.

The task of changing this long-standing pattern of relative avoidance falls primarily to the analyst. He or she is the one who must set the tone, carry out detailed inquiry, work though personally ambivalence about money matters and get past the social construction that fosters the “money taboo.’ Thus, if the patient were to ask, “Would you spend this time with me if you were not getting paid?”, the analyst needs to be open to a realistic response. The essence of the explanation is, “No, I would not.” Of course this requires elaboration, and there are exceptional circumstances, temporary suspensions of payment, low-cost analyses, and other varieties of economic arrangements, but the fact remains that the analysts works for a living. The analyst needs to be paid to survive, just as the patient does in his or her occupation. None of this disavows altruistic motivations, or genuine interest in people, or a host of other motivations, but the fact is, what the analyst does with any patient is the analyst’s work, for which the analyst expects to get paid.

 
References

Bergler, E. (1959). Money and emotional conflicts. New York: International Universities Press.

Frawley-O’Dea, M.G., & Sarnat, J.E. (2001). The supervisory relationship. A contemporary psychodynamic approach. New York: Guilford Press.

Freud, S. (1912). On beginning the treatment. Standard edition, 12, 123-144.

Herron, W.G., & Welt, S.R. (1992). Money matters. The fee in psychotherapy and psychoanalysis. New York: Guilford Press.

Klebanow, S., & Lowenkopf, E.L. (Eds.) (1991). Money and mind. New York: Plenum Press.

Krueger, D.W. (Ed.) (1986). The last taboo. Money as symbol and reality in Psychotherapy and psychoanalysis. New York: Brunner/Mazel.

 
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