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By what principles is the price for a consultation with a psychologist or psychotherapist formed, why and how much should they pay?
What does money mean in psychotherapy, are discounts possible, what is the difference between free and paid psychological help – these and other questions about money are answered by Daniil Nesterovich Khlomov, director of the Moscow Gestalt Institute.
Psychologies: What does money mean in psychotherapy?
Daniil Khlomov: Money here means relationship. Let me explain. For every type of human activity, for every specialty, money is filled with some kind of meaning. And this meaning is different for a financier and for a builder, for example. For a practicing psychologist, money is a relationship. And, accordingly, these relationships can be, for example, too big for one person, too alienated for another, and so on. But without this financial boundary, there will be no psychotherapy relationship between me as a psychologist and the person I work with.
Can’t a psychologist give the interlocutor some recommendations in a normal conversation?
D.H.: Maybe, but it won’t be psychotherapy. If I don’t understand why in a normal conversation, for no reason at all, I start to psychologize, then something is wrong with me, maybe I lack a sense of self-importance or something else – in this case, it’s time for me to tackle some solutions. their own problems.
What does money change?
D.H.: The money that the client pays for the work of a psychotherapist is some primary frame, confirmation that during the agreed time I am with this person not to satisfy my needs, but to help him.
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That is, while people communicate without payment, each of them satisfies his own needs, and when one pays, then the other satisfies not his own, but his needs?
D.H.: Exactly. In any case, this is how it should be in honest communication. Sometimes this balance is disturbed, but how and why, this must be understood in each individual case. Psychotherapy also deals with this – cases of disturbed balance in communication.
How else, besides payment, is the relationship between the client and the therapist different from the usual relationship?
D.H.: The therapeutic relationship is much simpler than other personal relationships between people. Usually, relationships between people are very complex, they are constantly changing, even if these are stable relationships and their participants have known each other for a long time. But one needs to talk, and the other is busy at this time. Or one has found out something about the other and has not yet decided whether to tell him or keep silent, and this knowledge becomes a pitfall in their relationship. In personal relationships, not everything is said out loud, you have to guess a lot. When something happens in these relationships, it is often not clear what it is connected with: whether with one participant, with both, or with some other circumstances.
How are relationships built in therapy?
D.H.: The relationship between client and therapist is much simpler. Their participants conclude a contract, they agree on all the conditions, discuss them aloud. We meet at a certain time, and it is clear to both of us that, after the time is up, we do not go to be friends, but simply disperse. I stay on my territory, even if the client wants to talk, even if there are feelings and he is ready to pay extra. But we have an agreement, and we act in accordance with it. And this is good, because in this case everything that happens between us does not refer to our relationship, but either to one person or to another. We remove all unexplained factors from our relationship. We express feelings in words, and not in some other way, as is the case in other relationships. For example, people build houses side by side, but behind this is their personal sympathy for each other, which is expressed like this – through joint activities. Or vice versa, someone does not like someone, and people refuse cooperation and profitable offers, thus expressing their antipathy.
How is the price of psychotherapist services determined?
D.H.: There is an average price, the same as in the rest of the world, it is known.
What about those for whom this price is too high?
D.H.: The good thing is that working with a psychologist is not mandatory for life. This is a service that you can buy for yourself, like other services. If it is not available to you, and there is a need for psychological knowledge, you can find information in psychological books, films – there are very good ones among them – and work independently.
But is there a difference between trying to solve your problems on your own and working with a psychotherapist?
D.H.: There is a difference. But that doesn’t mean that only one thing is possible. The same need can be satisfied in different ways. I will explain with the help of an example – you can buy a piece of bread, cheese and beer in the nearest store, go to a public garden and drink and eat it all on a bench. Or you can go to a restaurant. You will be satisfied and enjoy both in the first and in the second case. The question is what is more pleasant for you at the moment. Besides, one does not cancel the other.
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When does a person get the feeling that he does not have enough money?
D.H.: It depends not so much on objective reality as on the ratio of income and expenses. Some high-income people sometimes spend too much and don’t have enough money, despite the fact that they seem to get enough of it. In general, if you have little money, it means that some of your needs remain unsatisfied, and then you need to deal with this and put yourself in order.
Are there any special nuances in working with those whose incomes are high?
D.H.: It is difficult to work with those whose income and expenses are much higher than the average. Firstly, with his own money, such a person can buy himself any headache. Secondly, if such a client pays the money that is tangible for him, then this may be too much money for a specialist. And then the specialist will not be able to work, because his own balance will be disturbed. But there are ways to deal with these issues.
Which for example?
D.H.: For example, I had a client who, due to his position, was used to paying off everything, replacing real relationships with money. For him, it was a habitual way of doing things. And it was important not to give him such an opportunity in order to provide a more realistic background for the relationship. Therefore, we agreed that payment for psychological work will be deferred until certain results are achieved. For him to feel indebted for some time, to experience it as some kind of obligation, an attachment that he avoided in his life. And it worked. Money is an instrument of psychotherapy. Many practicing psychologists use salary increases and decreases as a tool to help clients solve their problems.
And yet, are discounts possible for low-income customers?
D.H.: They must be very justified from a psychological point of view. If we consider the exchange of money as a relationship, then a decrease in pay means a worsening relationship. And experience shows that after a downgrade, relationships really get worse, people become less attentive to each other, so a discount is not always a good thing. I’ll give you an analogy again. Some people prefer to buy things in a more luxurious, expensive store, although the quality of the goods there is not much higher than in the clothing market. But they are ready to pay for convenience, for the opportunity to choose what suits them calmly, without crowds and noise – that is, they pay for attitude. And during discounts and a normal store turns into a giveaway. Therefore, it is important to pay – both for psychotherapy and for other services – no less than you can. If I pay and buy cheaper than I could afford, then this is at the same time treating myself as less important than I really am.
What is the difference between the work of psychologists in free crisis centers and the work of a private psychotherapist?
D.H.: Free psychotherapy means that there a specialist will be interested in removing your symptom. If you have, say, insomnia, then his task is to make you just fall asleep. And perhaps the best thing to do is take a pill. He should not, out of obligation, together with you, find out the circumstances of your life that you want to understand. And in the event that you hire a private psychologist, you deal with him in a variety of circumstances in your life. And there is another factor. Collaboration with a private psychologist is a long-term project. It is difficult to learn many important details about a person in fifteen minutes or even an hour. This knowledge arises gradually, due to the effect of accumulation. Money metaphorically has the same effect, it accumulates. This means that contributions are growing on both sides, our relationship becomes more expensive with each meeting, and this means that we can talk about more and more complex things.