Greed is a ubiquitous human phenomenon. Since psychoanalysts are human beings, we too can feel greedy. Greed can be manifested in many ways. A young analyst with a family to support might feel greedy for patients to bolster her income; a very senior analyst might be greedy for patients and supervisees, because her work with them fosters a feeling of being needed and having something useful to give at a time in her life when much else is being lost. Analysts can sometimes feel greedy about making interpretations in their haste to show the patient what the analyst has understood about the patient (and to feel helpful and admired) whether or not the patient is ready to hear it. There are many examples of the manifestation of greed by an analyst. Some are very subtle, and there may be theoretical differences about whether or not a particular stance or behavior on the analyst's part should even be labeled greed. Some are more overt, and most analysts would agree that something was going on with the analyst and in the analyst/patient dyad. I will describe a brief clinical vignette to illustrate my own sense of greed, as it manifested itself in my work with a patient, and how I came to understand it.
Mrs. B* was an elegant, beautifully coiffed woman in her late fifties who came to see me early one spring day, after returning from her winter home in Arizona. She had been given my name by her boyfriend's analyst and had heard I was an “excellent analyst.” She needed an excellent analyst, she said, because “so many of the ones I've previously had were incompetent at worst and mediocre at best.” She felt that none of them had been able to help her with her lifelong recurrent depression. Its source was unclear to her, and medication had helped only temporarily. She had been widowed for about seven years and currently had a “gentleman friend” she enjoyed spending time with, but did not feel ready to make a major commitment.
Over time, Mrs. B revealed that her childhood had been marked by her mother's postpartum depression after giving birth to her. This had not happened after the births of Mrs. B's sister and two brothers, who were much older, ranging in age from 14 to 20 years her senior. Mrs. B suspected that she had not been planned and had arrived after her mother assumed she was done having children.
Mrs. B's father had been a successful and innovative businessman, who was loving toward the children when he was not out of town for meetings or visiting the sites of his ongoing projects. Her older sister helped look after her, as did a housekeeper who worked for the family during the week. Her mother's depression, lack of engagement, and subsequent difficulty in being able to attend to Mrs. B's emotional needs, combined with her father's lack of physical presence, had left scars on Mrs. B's functioning.
In her twenties she married a wealthy, somewhat older man who, like her father, was often away and, like her mother, was emotionally disengaged when physically present. When he died seven years earlier, Mrs. B crossed the boundary from being rich (which she already was, having inherited money from her parents' estate) to being independently wealthy. She had never been interested in having children and said she had never regretted being childless. The thought of looking after a constantly needy little creature had been abhorrent to her, and she felt she would not have handled the situation well. Her husband had not objected to this decision, stating that with all the traveling he was required to do, it would be hard for him to be a father.
Mrs. B said she struggled with an underlying sense of depression all the time, even though she functioned well in many areas of her life. She wanted to take care of this problem before she got much older, because she had a sense that if left unaddressed, it would make old age (when other challenges would come her way) even more difficult. Her three previous analytic treatments had involved an analysis of seven years' duration followed by two psychotherapies, at a frequency of two or three times a week, each for four to six years. From her description, it seemed the treatments had largely focused on her feelings about her father's frequent absences from her life and the pain of her mother's disengagement.
I suggested that given the lifelong depression she wanted to fully understand, her previous treatment, and her wish to improve her emotional understanding of herself an analytic treatment five times a week would be a useful way to proceed. She readily agreed,
Aisha Abbasi, M.D., is a training and supervising analyst at the Michigan Psychoanalytic Institute and the current president there. She is the author of The Rupture of Serenity: External Intrusions and Psychoanalytic Technique, (Karnac Books, 2014).
saying that her gentleman friend (who had found analysis extremely helpful) had encouraged her to consider it and that she was eager to start.
Then something unusual happened. As I began to discuss the treatment framework with her, it was easy to discuss matters related to frequency, appointment times, my cancellation policy and vacations. However, when I broached the fee I found myself in a dilemma. As Mrs. B was very wealthy, I debated charging her more than my customary fee. At that point in my career, this had never been a serious issue with any other patient, although many years later, I experienced a similar urge with a very wealthy male patient and could not sort out the determinants of it on my own and sought consultation with a colleague. I generally worked within a certain fee range, and revised the range every two to three years. I had heard from colleagues that if they treated an especially wealthy patient they raised the fee. Their reasoning was that for such a patient, the analyst's customary fee might seem a mere pittance and have no major financial impact on the patient; treatment, therefore, would not be valued. I wondered whether my resistance to this approach was based on reason or masochism, and decided that to increase the high end of my fee range for a wealthy patient did not make sense and would be inauthentic.
I had heard from colleagues that if they treated an especially wealthy patient they raised the fee.
Why, then, was I feeling greedy about money with Mrs. B? What did it mean that I wanted to raise the bar, just for her, by $20 a session? And what was it about Mrs. B that had aroused my hitherto slumbering greed about money with a patient? I also found myself thinking that she had had three previous treatments, and had come to me with a very high opinion of my “excellence” as an analyst. She would need a lot of help, and I might be the only analyst who could provide it. I was, in this way, getting rather caught up in a sense of my specialness and importance as her future analyst, which was also unusual for me. Intrigued by these ideas, I decided to set her fee at my usual rate and see what came up in the treatment and in my mind.
It did not take long for me to discover that Mrs. B's beautifully composed external persona disguised an internal self that felt damaged, ugly and unwanted. She was hungry—indeed greedy—for my time, attention and love, all of which had been in scarce supply from her mother and father. This was something she had learned to hide from others during her childhood, and it had not been fully expressed or deeply worked through during her previous treatments. I keenly felt the yearning within her to have more, the sense that she deserved more, and her wish to be very special to another person and, in particular, to a person who was special in some way (as she had expressed about me as an analyst and as I experienced her and her wealth). I could feel this and understand it, because I had felt something similar when I had the urge to charge her an unusually high fee. My greed for her money now allowed me to understand her greed for time, love and specialness with me. It became clear to me that in my unusual thought of wanting more than the usual fee from her, I had been warding off awareness of her wanting more than the usual analytic attention from me.
At a much later period in her analysis, Mrs. B shared that she had always wished she could have been the first child in her family, like her sister, who had probably received the most from their mother The sister was 20 years her senior I then realized that I had not let myself put together, what I had heard from her at our initial meeting, about the ages of all her siblings. It made sense that Mrs. B would want to be 20 years older; this might have given her the best her mother had to offer, before other children came along, life aged her, and depression claimed her few emotional reserves. I was struck now by the curious “coincidence” that I had considered adding an extra $20 per session to her fee. Was this an example of how much we unconsciously understand about our patients, and may express in an almost enacted form, before its meaning can be fully and consciously felt, articulated and understood?
In the vignette described above, I wanted to do something with my patient that I had never been tempted to before. I felt greedy in a way that was new for me. Against the background of my particular life history, and Mrs. B's, and our individual vulnerabilities, we pulled at each other in ways that were not immediately understandable. Initially, I was only aware of the wish to charge her more. It took me a while to understand that she, on the other hand, had come to see me with the wish to have as much of me as possible, and then some. I believe it was in an effort to ward off a realization of this “greed” in her that I began to feel greedy in a concrete way: a rather overt example of greed in the analytic setting and the significance of trying to understand and contain it, rather than act upon it.
The patient's identity has been masked to protect her privacy.