Letter to a psychotherapist

Payment for analytically-oriented psychotherapy and psychoanalysis

Dear Dr. Kim,

I am considering working with a Toronto psychotherapist who has been recommended to me. However, she wants me to pay for all scheduled sessions, even when I cannot attend, and to agree to give a month's notice when terminating. This seems unfair to me. When I asked her why, she said that analytically-oriented psychotherapy, which is what she does, has a much higher success rate if done this way. Is this true? If so, might another type of psychotherapy be less expensive? What do you do?

Dr. Kim replies:

This type of structure has been standard practice in analytically-oriented psychotherapy for a long time, and there are sound reasons for it. When on the verge of making a profound change, most people have an impulse, often unconscious, to avoid the issue--which is what they learned to do in the first place when the issue was buried and the neurosis was created. They tend to find that they are terribly busy or short of money and have to miss sessions, or to decide that they no longer have problems and can quit, etc. In the absence of the therapist's support and input at this crucial time, the client will typically resolve the conflict by going back to his old coping mechanisms, thus undoing much of the work so far. He may also conclude that therapy cannot help or that his particular therapist cannot help. So the standard structure is a way of containing the therapy and supporting the client in working the problem through.

As to whether another type of psychotherapy would be more cost-effective, that depends on what your objectives are and what method or methods will work for you to reach them. If the therapist you are planning to see is familiar only with analytically-oriented therapy, you may wish to first have an assessment with a therapist such as Jungian analyst Ingrid Dresher, who is familiar with all the main types and their uses.


Copyright 2001 M. Mares


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