The therapist's dilemma

[Dr. Richard Grossman]

Hi everybody,

I finally figured out why my therapists were all lousy.  A study by Ma-Kellams and Blascovich entitled “The Ironic Effect of Financial Incentives on Empathic Accuracy,” (Journal of Experimental Social Psychology--forthcoming) was covered by the Boston Globe (Sept. 23, 2012).  Quoting the Globe’s Kevin Lewis:

“People who were offered money as a direct reward for empathic performance instead exhibited less of it.  They were less able to infer the emotions of another person and described themselves in less relational terms.  The authors of the study conclude that ‘money causes individuals to focus more on self-related concerns and less on other-related concerns.’”

This week, I’m going to provide my services for free, and the week after, I’m going to ask my patients if I did a better job.  I may never charge again.

Richard

[Izzy_*now*]

Wow! I can relate, because as a 'patient' all I could think of was money I had to pay and not my other problems, while wondering if the therapist was wondering if my cheque would bounce and want all his words back!

Then I'd go home and think, 'What a waste of our time!"

Thanks
Izzy

[sKePTiKal]

During T, I had what's probably a common thought among patients...

wow. I'm so pathetic I have to pay someone to pretend to be my friend and pretend to care about me.
But, I was so miserable at that point... I was willing to ignore the cynicism, for the simple experience of emotional caring.

[KayZee]

wow. I'm so pathetic I have to pay someone to pretend to be my friend and pretend to care about me.

I've felt like that too.  And the empathy I found in therapy seemed to highlight the lack of it in my natural born family.  Made me feel like "if only I were good enough" I wouldn't have to pay for this... In retrospect, I see that meant a therapist's office was exactly where I needed to be.

Anyway, I loved my therapist.  And didn't often feel like she was putting her financial priorities ahead of the kind of support and treatment she felt I needed.  I totally respected her need to support herself and family and make a paycheck... If T's don't take care of themselves and their needs, how are they going to take care of the patients and people who rely on them?

Kay x

[lighter]

I didn't find lack of empathy to be the cause for my T's failure, which wasn't their fault, IMO.

There simply weren't any answers available to give, and they felt just as lousy as I did every time I left their office, IMO.  It was bad for me and for them, IMO.

I will say that thousands of dollars in payment may be partially responsible for a recent situation.  The T was supposed to be an impartial court officer, but instead turned into a biased advocate for the party paying their fee.  I'm not saying the fee was strictly responsible for what happened, but it had something to do with it, IMO.

I can see payment adversely affecting treatment in many different ways, and I suppose it depends on the T. 

Lighter

[Hopalong]

And...if the state provided therapy, iow mental health services, as part of universal health care?

http://en.wikipedia.org/wiki/Community_mental_health_service

The state could pay therapists as it did physicians, and thus the subliminal transactional empathy-obstacle between individual Ts and individual clients would be removed.

What's unfair to Ts (and to people who need therapy) is the class system. Those who have good health insurance or higher incomes can afford private therapists.

I think access to caring, skilled therapists should not be a middle-class+ privilege.

Hops

[sKePTiKal]

I should clarify my statement, Kay --

in my case, I'd learned from my NM that, that kind of "caring" was the velvet glove that masked the iron fist about to knock me down. I seriously distrusted empathy or sympathy or caring directed at me. I was adept at pushing people away from me - and then, eventually wondering why I was so alone. LOL...

Attachment issues - a person gets twisted up, inside-out, upside-down, backwards through the rabbit hole. A kind of permanent "opposite day".

In some strange way, I trusted the T relationship more -- because I was paying her; perhaps because of my attachment issues. I trusted the caring/transfer finally, deeply enough and long enough, enough times... that I could walk on and carry the feeling with me - touch it when I needed it. We'd finally finished polishing those grooves and reinforcing those neural connections in my brain.

[rosencrantz]

Interesting - I was always more confident and competent as a volunteer than as an employee.  The money transaction of being an employee filled me full of dread - or rather, the thought of being paid to be in charge.  I was completely incapable of going after a job I was best suited for - too senior, paid too much.  And yet, I could fulfil a similar role as a volunteer any day!  I now run my own business supporting lots of other people, helping them get over their fears and do a great job.  It earns me good money too - and them! But then the business started to falter.  One day I knew why - ye Gods, I'm only worth about HALF that amount!! LOL  Not funny really.  It has taken years to get my confidence back.  

And yes - my therapist is crap.  I'm sure it's because she's being paid by me because we really took a shine to each other before we formalised the deal, the 'shine' is  why I chose her!! But the need to meet my needs is killing the deal.