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Contemplating Raising Fees: An Exercise in Therapist Disquiet.

Jerome S Gans1

  • 1A Distinguished Life Fellow of the American Group Psychotherapy Association and the American Psychiatric Association. Now retired, he previously worked in private practice and as Associate Clinical Professor of Psychiatry, Harvard Medical School.

Psychodynamic Psychiatry
|December 6, 2021
PubMed
Summary
This summary is machine-generated.

Raising psychotherapy fees involves complex emotional and ethical considerations for therapists. This paper explores these dynamics and offers strategies to manage the stress associated with fee increases.

Keywords:
countertransferencefeesmoneypsychodynamic psychotherapy

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Area of Science:

  • Psychology
  • Psychotherapy
  • Private Practice

Background:

  • Psychodynamically oriented therapists in private practice often face challenges when considering fee increases.
  • The process can evoke a range of complex emotional and ethical issues for clinicians.

Purpose of the Study:

  • To explore the multifaceted experiences and psychological dynamics therapists encounter when contemplating raising their fees.
  • To provide practical suggestions for managing the stress and complexities involved in this process.

Main Methods:

  • The paper presents a discussion of the subjective experiences of therapists.
  • It categorizes the identified dynamics, including issues of power, guilt, entitlement, fear, self-care, and self-esteem.
  • A cautionary case example is included to illustrate the concepts.

Main Results:

  • Fee increases trigger competing self-interest, transference-countertransference issues, financial considerations, ethical concerns, and self-reflection.
  • Key dynamics identified include the exercise of power, guilt, entitlement, fear of loss, modeling self-care, rapaciousness, unconscious factors, and self-esteem.
  • Six suggestions are offered to alleviate therapist stress regarding fee adjustments.

Conclusions:

  • Raising fees is a complex process for psychodynamically oriented therapists, involving significant emotional and ethical considerations.
  • Open discussion and understanding of these tensions can lead to better management and acceptance of the associated feelings.
  • The paper aims to foster a more supportive environment for therapists navigating fee adjustments.