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The literature concerning theory and methodology relative to the collection of fees is sparse. This is odd, since the process is so inevitable in psychotherapeutic practice. A flurry of articles regarding fees has appeared in recent years mainly because of the increasing importance of third-party payments in psychotherapy. The emphasis has been primarily on whether such outside payments affect the therapeutic process. Generally the answer has been that it does, though there is controversy over the extent and importance of its influence. Little has been written about the actual practice of such ubiquitous therapeutic processes as billing, the receiving of payments, dealing with missed therapy hours, determination of fee, charging different fees to different patients, and especially how all the ramifications of fees in the therapeutic process fit with the therapeutic orientation of the therapist. It is my purpose in this paper to review some of the central issues which have appeared in the scant literature, and to develop an orientation to fees which emanates from one therapeutic stance.
Since there is not a great deal in the literature about fees, it may be concluded that there is a general unwillingness to deal openly and actively with a transaction that may be justified within the context of the modern commercial world, but which carries, for some, an undesirable mercenary tone. Psychoanalysts (perhaps this is true of the helping professions generally) like to see themselves as beneficent purveyors of good rather than as people involved in commerce. Chodoff (1964) points out that one way of characterizing an analyst is as an individual entrepreneur, selling a service in competition with others in his profession and allied professions. He goes on to state that the economics of psychoanalysis