Hostage of the Fee: Meanings of Money, Countertransference, and the Beginning Therapist

The issue of money and fees for treatment is one of the most inadequately discussed issues in the psychotherapy literature. Despite its relevance to every psychotherapy, and its irrefutable impact on the psychotherapeutic relationship, there appears to be a resistance among us to exploring this issue either in our literature or in our training. This discussion highlights some of the meanings of fees in the arena of psychoanalytic psychotherapy, and poses some possible explanations for its absence from our literature and training. Case material is presented from the author's beginning psychotherapy practice. Transference and countertransference issues are discussed, as are some more general experiences and impressions of the author having to do with money, values, and the ethics of professional practice regarding fees. The importance of more open discussion, especially among beginning therapists, and therapists in training, about money and fees, as well as their countertransference implications and transference influences on the therapy, is emphasised. It is argued that with the increasing number of cases involving third-party interference, it is imperative that the issue of fees, and its impact on the therapeutic process receive more attention in training.