Why Patients Pay? The Multiple Meanings of Payments for Therapy

• In Event: Culture and Economic Life

Abstract

This chapter analyzes the meanings of payments for therapy, based on in-depth interviews with Argentine therapists. At a basic level, payment compensates the therapist for professional work. However, for psychoanalysts, money carries multiple symbolic meanings and functions. It demarcates the therapeutic space, distinguishing it from intimate relationships like friendship or love. It also represents the patient’s effort and engagement in therapy. Doing therapy requires work by the patient, and the economic cost is blended with the emotional and psychological effort required for treatment. Paradoxically, patients both work and pay.

Therapists frequently use economic terms like cost, pay, investment, loss, or demand but in ways that fuse financial and emotional dimensions. Payment is sometimes framed as an investment, yet psychoanalysts emphasize a deeper meaning: loss. Doing therapy should not be treated as a speculative endeavor seeking guaranteed gains, but as a process in which economic and symbolic loss reflects their willingness to relinquish symptoms and the paradoxical enjoyment those symptoms provide.

Despite the significance of payment for the treatment, Argentine therapists may offer free or low-cost sessions, by interpreting non-monetary contributions (commitment, effort, or engagement) as forms of payment. They also conceptualize providing free treatment as their own gamble on a patient’s future improvement (both psychological and financial). Finally, psychoanalysts see their particular form of listening, giving up a part of themselves to serve the therapeutic process, as a payment by the therapist.

Thus, payments for therapy serve as a material, symbolic, and relational medium, showing how financial, therapeutic, and emotional dimensions intersect.

Author

• Daniel G. Fridman, University of Texas-Austin