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This paper considers a seldom-discussed feature of assessment, namely, the significance of the setting of a fee and its connection with the setting in which a fee is agreed. Its importance is illustrated with reference to the three-times-weekly sessions over a period of one year with a single woman in her 30s. It will be seen how, in much the same way as aspects of her earliest history coloured her development from the start, the experience of setting the fee in the first session of treatment influenced subsequent features of the work.
In this case, the charging of a lowered fee will be shown to have affected the nature of the therapeutic relationship and it will be seen how the issue of payment of a fee at all provided a focus from which psychodynamically important material could be developed. It gave opportunity for the testing and working-through of a number of elements, both conscious and unconscious, throughout the first year of treatment. That is, the issue of the fee was found to be grossly over-determined — symptomatic of roots in several quite separate feelings and memories, each of which had to be uncovered before the issue could begin to be resolved.