The fee in psychotherapy: Practitioners' accounts

This paper addresses the real and symbolic significance of fee-paying in the psychotherapeutic relationship through the context of available (mostly American) literature in this area and the extent to which the concerns expressed in the literature are reflected in the attitudes of a small sample of psychotherapists in Britain. Therapists were interviewed to establish whether they saw fee-paying as an essential or important element in the therapeutic relationship, whether they saw its presence or absence as affecting process or outcome and whether any counter-transferential issues could be deduced from the way therapists explored their money-relationships with their clients. Analysis of the interviews reflected the debates in the literature and indicated that those who felt most strongly that fee-paying was essential for effective psychotherapy, and that the payment of a fee was symbolically important for their clients, were also those who were most heavily dependent upon fee-paying for their livelihood and who tended to be less likely to express ambivalence about receiving money. Speculations on the basis of this research centre around whether therapists may assert client need in order to defend themselves against or legitimate their own need.