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Before turning to Dr. Altman's thought-provoking presentation of his work with Geraldine, I'd like to address some of the issues he raises at the end of his remarks. Obviously, questions of financial and emotional gratification are inherent in the structure of any therapeutic relationship. Certainly we are also aware of the complex interplay of perpetrator/victim that informs the transference-countertransference paradigms in our treatment of children who have been neglected or abused. However, Dr. Altman suggests that the particular structure of The Children's Psychotherapy Project may bring some of these questions into sharper than usual relief, and I think we can productively use this opportunity to consider them.
While I was preparing this talk, three vignettes about payment for psychotherapy came to mind that I'd like to share with you.
First, a tale from many years ago when I was a teaching assistant for Judy Wallerstein, who had recently moved to the Bay Area from Topeka: She sometimes talked about a gentleman who “visited” with Karl Menninger on a weekly basis. They often chatted about the weather, a very important topic in the farming communities of Kansas. Sometimes they discussed the current prices of wheat or hog backs; sometimes the conversations turned to more personal topics. At the end of each meeting this gentleman handed Dr. Menninger a dozen eggs that he had carefully gathered from his hen house.
Moving to the present: I have been working with a little girl, now aged 7, for a bit over two years. Her parents bring her regularly and pay my full fee promptly each month. I find her absolutely charming—much of the time. At other times I am subjected to the obstinate whining and stubborn refusals with which she tortures her mother on a daily basis. Generally we work well and hard together. In other words, this is an ideal case, except for one