On Some Theoretical and Technical Problems Regarding the Payment of Fees for Psychoanalytic Treatment

The earliest medical help given to man by man probably took the form of magic rituals. It was dispensed not by a specialist, but by a person to whom many other functions of import to the community had also been entrusted. In later phases of cultural development, the fight against disease and illness did come to be entrusted to specialists: Hippocrates was the most famous among those early figures who can be called 'physicians' in the modern sense. When protecting health became a specialized function, medical service was rewarded; physicians were richly compensated by kings and by others in power. Yet the practice of healing and that of charity remained intertwined for a long period, particularly during the Christian era. It was not so long ago that the image of a physician was still surrounded by a kind of halo of saintliness—the implication being that he would employ his arts of healing without compensation. In the Oath of Hippocrates, which says: 'With purity and holiness I will pass my life and practise my art', there is already a strong indication that this was so.

When Freud started his medical practice, the way in which a physician was compensated was different from the customary way of compensating other professions. At the end of the year, he would send a bill that covered all his medical services during the preceding 12 months. The patient's daily visits to the psychoanalyst's office made it impracticable to render a bill on either a daily or an annual basis, and for that reason the analyst's monthly statement—which, although many problems and doubts are attached to it, may appear the only detail of psychoanalytic technique on which all analysts seem to agree—requires no particular historical inquiry.1

'Ordinary good sense', Freud wrote (1913, p. 131), 'cautions him [the analyst] … not to allow large sums of money to accumulate, but to ask for payment at fairly short regular intervals—monthly perhaps', and he added that that was not the usual pract