On the Setting of Analytic Fees

Among the exceptional features of a psychoanalysis is the requirement of frequent visits over a long period of time. That, of course, entails the payment of a very substantial sum of money. Many patients have limited financial resources. In regard to this issue, it is common to hear references to the need for a "reduced fee." It is the meaning and use of this term—for the analyst and the patient—that I want to discuss.

What does "reduced fee" connote? The implication would seem to be that the analyst has a usual fee—the so-called "full fee"—which he/she is offering to lower for this particular patient.1 It would seem to present the analyst's view of him/herself as a person whose services have a high and specific value. Does it also imply that this patient is so worthwhile and interesting a person that the analyst is willing to make this special arrangement? How does the patient experience this indication of interest or favor? How does the patient deal with the question of whether the analyst would be willing to make this arrangement if the analyst could fill all of his/her time at the "full fee"? The disappointment and the injury to the analyst's feelings of self-worth when appropriate analytic cases are not easily available may contribute to the importance of the term "full fee" and the diminishment reflected in the term "reduced fee."

I am attempting to underscore the consequences of what has become an unexamined convention, the terms "reduced fee"