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Presenter: I have not prepared a case for presentation –
Bion: It is just as well to get used to the fact that you are unprepared. There is nothing more to be said about what you are prepared for; what you know, you know – we needn't bother with that. We have to deal with all that we don't know.
P: I would like to talk about a patient, a young woman of twenty-five, who has been in analysis with me for a few months. She insisted that she wanted to be seen by me so I arranged an appointment. When she arrived I was impressed by her appearance: everything about her was like spring, but the story she told me about herself was not, and certainly did not accord with my feeling that she was charming and full of love. I thought I would like to accept her for analysis but she couldn't afford my usual fee and didn't want to ask her father for the money. So I lowered my fee so that she could have five sessions a week.
B: This is a very important point. We never know anything whatever about the patient's financial capacity – nothing. What we do know about is the bill we shall get tomorrow at the supermarket; it is no good saying, “Look, I can't pay you for this food, but I've got a very charming girl patient, so will you give me the food free?” You cannot really say that you will lower the fee – or at least you can say it, but whether you can afford it is a much more serious matter. Although it is difficult to know how much money we need, we can have an idea of what it costs us to remain in existence. A patient can say, “I may not be able to pay, but I want the very best doctor, the very best psychoanalyst. I don't want polluted food – I want the best.” But who is going to pay for it? The apparently simple request made by this very attractive girl means that you are invited to feel she is
worth paying for – in other words, seeing her for less and thus paying the fees she can't pay. If you are very wealthy or have independent means, you might appear to be able to pay the fees. Bu