Free Psychotherapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Many of my friends honestly say: I would go to a psychologist / psychotherapist if I didn't have to pay for it. To this I usually answer: it means that you are not ready to go to a psychotherapist

Why? Are therapists greedy? Are psychotherapists afraid that all clients will want to work for free? Are psychotherapists prohibited from accepting clients without payment? Everything is much simpler. Usually, if a person is not ready to pay for changes, it means that he is not ready for the changes themselves.

From the point of view of professional ethics, accepting clients for free is not allowed. Not because it is dumping. But because it significantly reduces the efficiency of the process. And not at all because the therapist lacks motivation, if the client does not leave a significant amount of money on the nightstand every time. My colleagues from European countries, where psychotherapy is included in the insurance, said that those clients who pay out of their own pocket change more efficiently than those for whom the insurance company pays.

In both cases, the psychotherapist receives an agreed fee, in both cases it is important for the specialist to retain the client and achieve positive changes - but in the second case, the psychotherapist encounters much more resistance, much more refusal to work or self-sabotage on the part of the client.

Psychotherapy is the responsibility of all the participants, and the client bears his part of the responsibility - otherwise it turns out that the therapist literally "adopts" him and pulls on himself, which means that the client himself does not make efforts to change. Psychotherapy is a serious internal work, and if the client himself does not want to take responsibility, the hours spent will never pay off. And the monetary payment for the work of a therapist is not only a salary for a specialist, but also a symbolic expression of the client's responsibility. In addition, each of us treats items acquired for some investment much more carefully than for what we got without effort (gifts from loved ones do not count). And finally, the client values his time much more if he pays for it: there is no point in being late, lying, talking “about something else” and generally sabotaging the process. If a person pays for the time spent in the office, he appreciates it and protects it, not wanting to "squander" in vain.

In theory, psychotherapy should always be paid. But in reality, there are sometimes exceptions. First of all, these are training sessions required for a specialist for certification or simply for gaining practical experience. Here is a barter exchange: the client agrees to become a kind of "experimental", preparing in advance for the fact that the therapist may make a mistake. In addition, often in this situation, the client knows that many people will hear and learn about his case, and not only the supervisor of his therapist (teachers, fellow practitioners of the novice therapist). In this case, all the rules related to the scope of therapy are slightly changed in accordance with the contract. Thus, the client, in one way or another, pays for the treatment with his safety and the absence of any guarantees. By the way, this is not at all as bad as it might seem. A student or a novice therapist can be more attentive than his experienced colleague, he is motivated to do his job in the best possible way, and the newly acquired knowledge and skills are still fresh in his memory.

Another situation is when an experienced therapist, accustomed to taking money for his services, is approached by a person in a crisis situation who, by all indications, really needs help, but is not able to pay for the services of a specialist. Different psychologists relate to this practice in different ways, but most of them have encountered situations when "it is impossible not to take it."

In such cases, payment is still needed: purely symbolic or, in extreme cases, in the form of tasks that the therapist sets for the client. Irving Yalom, one of the most famous American psychotherapists, once asked his client to write detailed reports on each meeting as a payment. The girl needed therapy, but was unable to pay for the services of a specialist. She was also an aspiring writer in a creative crisis, so the need to write was good for her. Over time, combining his notes with her reports, Yalom co-authored with her the book "Chronicles of Healing" - an excellent work, where the process of treatment of a difficult patient, the changes that happened to her during the course of therapy, are clearly recorded. But the resulting wonderful book is not the main thing. The main thing is that the patient constantly made a significant contribution to the process, which means that she had motivation to work and her own, peculiar way of payment.

The method of payment for an insolvent client can be any creative activity or symbolic retribution, the main thing is that the client invests in the relationship, gives something back and appreciates what he receives in return. But you should not provide psychotherapeutic services in the usual "barter" mode - for example, in exchange for language lessons or hairdressing (photographic, cosmetology, coaching, etc.) services provided by the client. This violates the delicate therapeutic alliance and is considered a direct violation of ethics.

By the way, my first therapist once worked with me almost for free: a student psychologist literally fell on his head in a difficult life situation, who really needed help - but she had no money. Then the therapist took from me a purely symbolic amount, something about two hundred rubles (and by the way, even they often had to be borrowed). But I had a huge motivation to work, in addition, in my then life situation, I scraped up this ridiculous money. For comparison, that specialist already then (many years ago) charged several thousand rubles for an appointment from his “ordinary” clients. An important condition of my therapy for “ridiculous” money sounded like this: “One day, when you become a tough, highly paid psychotherapist with a bunch of clients, a girl or boy will come to you who will really need help, but will have nothing to pay for it. Then we will pay off. I had no choice but to become a professional with a bunch of clients.