Saturday, August 20, 2016


Let's face it, times have changed.  Our field has to keep up with the world. One of the biggest changes since Freud's day has been the triumph of capitalism.  Everything has become a commodity.  People want to see value for their money---its not enough to ask people to pay us a fee just because we spend time in the same room with them, even if we were thinking about them the whole time.  Its the age of transparency! People want to know what we are doing during a session and why we think its worth money.  In the interest of informed consent, its time we gave new patients a price list, a list of what we do and what we think our work is worth.  We don't have to compromise on our principles, we just have to be clear about how we assign value.  Here's a sample of what I mean:

1. Staying silent and blank faced when the patient enters the room:  $100.  (We know how difficult it is to do this, especially when the patient enters crying, or some such thing.  We should be paid handsomely for the effort this takes.  If we get sloppy and say "good morning" deduct $50; if we forget our principles and say "what's wrong?  deduct the entire amount especially if the tone is concerned.  After all, anyone can do that, and for no fee!)

2.  Not saying anything for the rest of the session:  $200.  It takes years of training to maintain such long periods of silence.  Why would anyone go for years of psychoanalytic training if they didn't expect to be compensated for the time and expense?   If one is able to maintain this silence in the face of a direct question from the patient, add a bonus of $50 per question.

3. If the analyst says one thing in the course of a session, of course it will be an interpretation.  Following is the price list for various interpretations, assuming that they are given sparingly (no more than one per ten hours of session time) and no more than ten words per interpretation.  If more than ten words are used, deduct 10% of the fee per word.
a: Oedipal interpretations $1000
b: Pre-oedipal interpretations: $500
c: Transference interpretations: $250 added if the transference interpretation is at an Oedipal level, $100 at a pre-Oedipal level.
d: Supportive comments: Deduct the entire amount of  a week's fees from the patient's bill.
e: Asking a question: Deduct the fee for the session in which a question is asked.
f: saying "uh huh": $10 per instance; $20 if no interest or concern is thereby conveyed.

4. For four sessions or more per week, the fee for each session is raised by $100 above the standard base fee.  More sessions make each of the individual sessions more valuable.  This may seem like it contradicts the usual idea of volume discounts, but hey, this is psychoanalysis.

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