Tuesday, October 8, 2013

Fees, egads!

In the TBIPS course Practical Analytic Subjectivity I the class reads some interesting papers on money (fees). Myers  writes from a relational intersubjective point-of-view and states that

The fee expresses the analyst’s desire.

Negotiation of the fee serves then to bring to the forefront conflicting desires of two subjectivities, and the opportunity for mutual recognition. With mutual recognition comes the possibility of greater intimacy. Myers puts it like this

the journey the patient takes to attain recognition and understanding of the therapist's separate needs is a desirable goal of therapy because it is the basis of real intimacy,

and so speaks to what Benjamin sees as “the underlying wish to interact with someone truly outside, with an equivalent center of desire.” Like Benjamin, Myesr, also relying on Winnicott’s ideas of survival, sees the joy in intersubjectivity:

the baby recognizes the mother anew and is cheered by her presence.


By experiencing a patient's aggression and surviving it, we also help the patient to see that others in her life can survive hardy self-assertion.

Myers continues

By showing patients that we have a subjectivity, we offer them the chance to claim their own subjectivity.   [and]

            When we ask more of patients, they have permission to ask more of 
            us and of their environment.

Shields comes from a more traditional point of view and speaks to a panoply of possible meanings attributed to money and the fee, from its classical connection to feces and the anal character, to guilt about success, worth and autonomy.  Conflicts over fees may bring up issues with masochism, sadism, altruism; fears of punishment, or of abandonment by patients.

In a courageously self effacing clinical example, Shields reveals his countertransference dilemmas (perhaps including homophobia) when his  patient attacks the analyst’s benevolence and competence, making it impossible for the analyst to play with his own sexual desirability. I was reminded of Neil Altman’s excellent paper on race and withholding of payment.

Altman, N. (2000). Black and White Thinking: A Psychoanalyst Reconsiders Race. Psychoanal. Dial., 10:589-605.
Myers, K. (2008). Show Me the Money:(the “Problem” of) the Therapist's Desire, Subject… Contemp. Psa, 44:118-140.
Shields, J.D. (1996).  Hostage of the fee: Meanings of money, countertransference, and the beginning therapist.  Psa. Psychother., 10:233-250.

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